Liang Mining, Zhang Beibei, Deng Lu, Xu Rong, Wu Haishan, Chen Jindong
Clinical Nursing Teaching and Research Section, The Second Xiangya Hospital, Central South University, Changsha, Hunan Province, China.
Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China.
Int J Endocrinol. 2019 Mar 21;2019:1312804. doi: 10.1155/2019/1312804. eCollection 2019.
To explore whether olanzapine alters bone mineral density (BMD), glucose, and lipid metabolism in schizophrenia patients.
This study enrolled 150 patients diagnosed with schizophrenia according to , including 101 patients who had over 6-month history of olanzapine use (olanzapine-treated group) and 49 patients who had no history of antipsychotic use (first episode drug-naïve group). 71 subjects with age- and gender-matched healthy volunteers (healthy control group) were also enrolled. All study subjects were from the Chinese Han population recruited in the Second Xiangya Hospital from January 2015 to January 2016. Demographic and physical examination data were collected from all subjects. BMD measurements of the radius+ulna, lumbar spine (L1-4), and left hip were performed via a dual-energy X-ray absorptiometry test. Serum lipid, glucose, and insulin levels were analyzed. Psychopathology profiles in all enrolled schizophrenia patients were assessed by the positive and negative syndrome scale (PANSS).
There was no significant difference in age, gender, activity intensity, smoking, or drinking among the three groups. In the majority of evaluated bone areas, the BMD values in olanzapine-treated or drug-naïve patients were lower than those in the control group. However, BMD values in the drug-naïve group showed no difference or even decreased as compared with those in the olanzapine-treated group. Among the olanzapine-treated group, although not observed in every tested region, a positive correlation was found of BMI or HOMA-IR with BMD. Stepwise multiple linear regression analysis revealed independent predictive factors associated with BMD in groups/subgroups of schizophrenia patients or healthy controls, including gender, TG, BMI, body weight, HOMA-IR, and FBG.
Schizophrenia, but not the long-term use of olanzapine, correlates with BMD loss in schizophrenia patients. Elevated BMI, TG, FBG, and insulin levels might protect these patients against bone degradation. Our work provides new information to improve the understanding, prevention, and treatment of osteoporosis in schizophrenia patients.
探讨奥氮平是否会改变精神分裂症患者的骨矿物质密度（BMD）、血糖及脂质代谢。
本研究纳入了150例根据[具体标准]诊断为精神分裂症的患者，其中101例有超过6个月奥氮平使用史（奥氮平治疗组），49例无抗精神病药物使用史（首发未用药组）。还纳入了71例年龄和性别匹配的健康志愿者作为健康对照组（健康对照组）。所有研究对象均为2015年1月至2016年1月在中南大学湘雅二医院招募的中国汉族人群。收集了所有受试者的人口统计学和体格检查数据。通过双能X线吸收法检测桡骨+尺骨、腰椎（L1-4）和左髋部的骨密度。分析血清脂质、血糖和胰岛素水平。所有纳入的精神分裂症患者的精神病理学特征通过阳性和阴性症状量表（PANSS）进行评估。
三组在年龄、性别、活动强度、吸烟或饮酒方面无显著差异。在大多数评估的骨区域中，奥氮平治疗组或未用药患者的骨密度值低于对照组。然而，未用药组与奥氮平治疗组相比，骨密度值无差异甚至降低了。在奥氮平治疗组中，虽然并非在每个测试区域都观察到，但发现BMI或HOMA-IR与骨密度呈正相关。逐步多元线性回归分析揭示了精神分裂症患者组/亚组或健康对照组中与骨密度相关的独立预测因素，包括性别、甘油三酯、BMI、体重、HOMA-IR和空腹血糖。
精神分裂症本身而非长期使用奥氮平与精神分裂症患者的骨密度降低相关。BMI、甘油三酯、空腹血糖和胰岛素水平升高可能保护这些患者免受骨质降解。我们的工作为增进对精神分裂症患者骨质疏松症的理解、预防和治疗提供了新信息。
