Department of Community Psychiatric Medicine, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan.
Japanese Society of Clinical Neuropsychopharmacology, Tokyo, Japan.
BMC Psychiatry. 2018 Jun 8;18(1):180. doi: 10.1186/s12888-018-1764-1.
Patients with schizophrenia have an increased prevalence of metabolic disturbances compared with the general population. However, the mechanisms underlying the metabolic side effects of antipsychotics are unknown. The aim of the present study was to compare the levels of high-density lipoprotein (HDL)-cholesterol in Japanese schizophrenia patients medicated with olanzapine, risperidone, or aripiprazole monotherapy.
This study was a post-hoc analysis of a nationwide survey, which included 433 Japanese outpatients with schizophrenia and 674 inpatients. A brief questionnaire was compiled that covered demographic data, systolic blood pressure, diastolic blood pressure, and HDL-cholesterol after reviewing the relevant literature and guidelines. To compare demographic and clinical characteristics, analysis of variance was performed for continuous variables and the chi-square test was performed for categorical variables. For comparisons of HDL-cholesterol levels among the three antipsychotic groups, analysis of covariance was carried out with age, diastolic blood pressure, chlorpromazine-equivalent dosage, and waist circumference as confounding variables after stratification by body mass index (BMI) for each outpatient group and inpatient group.
The mean age was 57.9 ± 14.0 years and the mean BMI was 23.4 ± 4.5 kg/m. HDL-cholesterol levels when stratified by BMI differed significantly (p = 0.019) between the three antipsychotic groups after age, diastolic blood pressure, chlorpromazine-equivalent dosage, and waist circumference in inpatients. A significant difference in HDL-cholesterol levels was only found in the overweight inpatient group, and no significant differences in HDL-cholesterol levels were found among the three antipsychotics for outpatients of all BMI stratifications or inpatients that were underweight or of normal weight. For post-hoc analysis of HDL-cholesterol levels in overweight inpatients, HDL-cholesterol was significantly lower in the olanzapine group than in the aripiprazole group (p = 0.023).
This study reveals a difference in HDL-cholesterol levels in overweight Japanese inpatients with schizophrenia resulting from the use of different antipsychotics. In the post-hoc analysis of HDL-cholesterol levels in overweight inpatients, HDL-cholesterol was significantly lower in the olanzapine group than in the aripiprazole group. Further studies incorporating more detailed evaluations, including diet and physical activity, are needed to clarify the differences in HDL-cholesterol according to antipsychotic use.
与普通人群相比，精神分裂症患者代谢紊乱的发生率更高。然而，抗精神病药物代谢副作用的机制尚不清楚。本研究旨在比较奥氮平、利培酮和阿立哌唑单药治疗的日本精神分裂症患者的高密度脂蛋白（HDL）-胆固醇水平。
这是一项全国性调查的事后分析，纳入了 433 名日本门诊精神分裂症患者和 674 名住院患者。在回顾相关文献和指南后，编制了一份简短的问卷，涵盖了人口统计学数据、收缩压、舒张压和 HDL-胆固醇。为了比较三组抗精神病药物的人口统计学和临床特征，对连续变量进行方差分析，对分类变量进行卡方检验。对于门诊和住院患者的每个亚组，按体重指数（BMI）分层后，采用协方差分析比较三组抗精神病药物的 HDL-胆固醇水平，以年龄、舒张压、氯丙嗪等效剂量和腰围作为混杂因素。
平均年龄为 57.9±14.0 岁，平均 BMI 为 23.4±4.5kg/m。按 BMI 分层后，三组抗精神病药物的 HDL-胆固醇水平差异有统计学意义（p=0.019）。在住院患者中，年龄、舒张压、氯丙嗪等效剂量和腰围校正后，仅在超重组中发现 HDL-胆固醇水平有显著差异，而在所有 BMI 分层的门诊患者或体重不足或正常体重的住院患者中，三种抗精神病药物之间的 HDL-胆固醇水平无显著差异。对于超重住院患者的 HDL-胆固醇水平的事后分析，奥氮平组的 HDL-胆固醇明显低于阿立哌唑组（p=0.023）。
本研究揭示了不同抗精神病药物治疗的超重日本精神分裂症住院患者 HDL-胆固醇水平的差异。在超重住院患者的 HDL-胆固醇水平的事后分析中，奥氮平组的 HDL-胆固醇明显低于阿立哌唑组。需要进一步的研究，包括更详细的评估，包括饮食和体育活动，以阐明根据抗精神病药物使用的 HDL-胆固醇差异。
