Baeza Inmaculada, de la Serna Elena, Calvo-Escalona Rosa, Merchán-Naranjo Jessica, Rodríguez-Latorre Pamela, Martínez-Cantarero M Carmen, Andrés Patricia, Alda José Angel, Muñoz-Samons Daniel, Ilzarbe Daniel, Arango Celso, Castro-Fornieles Josefina
1 Department of Child and Adolescent Psychiatry and Psychology, SGR-881, Institut Clinic of Neurosciences, Institut d'Investigacions Biomèdi ques August Pi Sunyer (IDIBAPS), Hospital Clínic Universitari of Barcelona , Barcelona, Spain .
2 Department of Medicine, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), University of Barcelona , Barcelona, Spain .
J Child Adolesc Psychopharmacol. 2018 Sep;28(7):463-473. doi: 10.1089/cap.2017.0117. Epub 2018 Jul 5.
To analyze liver function tests (LFT), weight, metabolic syndrome (MetS) and at risk of meeting MetS criteria (AR-MetS) in children and adolescents on antipsychotics (AP) during a year-long follow-up.
Two hundred sixteen patients, AP naïve or quasi-naïve (<30 days on AP), were included. Total bilirubin, the enzymes aspartate aminotransferase (AST), alanine aminotransferase (ALT), alkaline phosphatase (ALP), weight and other parameters of MetS were measured at baseline, and at 3, 6 and 12 months, while patients remained on the same AP.
At baseline, patients (mean age: 14.1 ± 3.1 years; 60.2% male) were on risperidone (N = 143), olanzapine (N = 37), or quetiapine (N = 36), although the sample decreased over time to 67 patients at 12 months (risperidone N = 46, olanzapine N = 10, and quetiapine N = 11). Around 3% of patients had ALT/AST levels that were at least twice the upper limit of normal (ULN) at 3 and 6 months; whereas roughly 19% of patients had ALP levels that were at least twice the ULN in at least one assessment after baseline, but had no clinical symptoms. From baseline to 6 months, significant increases were observed in ALT levels in the whole sample (p = 0.005), whereas ALP increased only in patients on risperidone. Patients showed significant weight gain, and more individuals met criteria for MetS and AR-MetS over time (from baseline: 2.8% and 8.3%, to 1 year: 10.5% and 23.9%, respectively). There was a trend-level group effect in global ALT across time (p = 0.076). Patients with MetS showed higher ALT concentrations (28.9 [18.4-39.4] U/L) than AR-MetS (20.4 [8.5-32.2] U/L), and no-AR-MetS (19.2 [8.4-29.9] U/L).
Less than 3% of children and adolescents on AP during 1-year follow-up showed an increase in ALT or AST levels in one or more of the assessments, and none of these increases was of clinical significance. Patients with MetS and AR-MetS increased during this period, and the possible role of ALT levels to monitor these patients deserves further study.
分析在为期一年的随访中，使用抗精神病药物（AP）的儿童和青少年的肝功能检查（LFT）、体重、代谢综合征（MetS）以及符合MetS标准的风险（AR-MetS）。
纳入216例初治或近初治（使用AP时间<30天）的患者。在基线时以及第3、6和12个月测量总胆红素、天冬氨酸转氨酶（AST）、丙氨酸转氨酶（ALT）、碱性磷酸酶（ALP）、体重以及MetS的其他参数，期间患者持续使用同一种AP。
基线时，患者（平均年龄：14.1±3.1岁；60.2%为男性）使用利培酮（N = 143）、奥氮平（N = 37）或喹硫平（N = 36），尽管样本量随时间减少，至12个月时为67例患者（利培酮N = 46、奥氮平N = 10、喹硫平N = 11）。约3%的患者在第3和6个月时ALT/AST水平至少为正常上限（ULN）的两倍；而大约19%的患者在基线后的至少一次评估中ALP水平至少为ULN的两倍，但无临床症状。从基线到6个月，整个样本的ALT水平显著升高（p = 0.005），而仅使用利培酮的患者ALP升高。患者体重显著增加，随着时间推移，符合MetS和AR-MetS标准的个体增多（从基线时的2.8%和8.3%，到1年时分别为10.5%和23.9%）。随时间推移，总体ALT存在趋势水平的组间效应（p = 0.076）。患有MetS的患者ALT浓度（28.9[18.4 - 39.4]U/L）高于AR-MetS患者（20.4[8.5 - 32.2]U/L）和非AR-MetS患者（19.2[8.4 - 29.9]U/L）。
在1年随访期间，使用AP的儿童和青少年中，不到3%的患者在一项或多项评估中ALT或AST水平升高，且这些升高均无临床意义。在此期间，患有MetS和AR-MetS的患者有所增加，ALT水平在监测这些患者方面的可能作用值得进一步研究。
