Department of Psychiatry, University Hospital Marqués de Valdecilla, Instituto de Investigación Sanitaria Valdecilla, Santander, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Spain; Department of Medicine and Psychiatry, School of Medicine, University of Cantabria, Santander, Spain.
Department of Psychiatry, University Hospital Marqués de Valdecilla, Instituto de Investigación Sanitaria Valdecilla, Santander, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Spain.
Prog Neuropsychopharmacol Biol Psychiatry. 2019 Dec 20;95:109677. doi: 10.1016/j.pnpbp.2019.109677. Epub 2019 Jun 20.
Increased incidence of obesity and excess weight lead to an increased incidence of non-alcoholic fatty liver disease (NAFLD). Recent evidence indicates a protective effect of cannabis consumption on weight gain and related metabolic alterations in psychosis patients. Overall, patients are at greater risk of presenting fatty diseases, such as NAFLD, partly due to lipid and glycemic metabolic disturbances. However, there are no previous studies on the likely effect of cannabis on liver steatosis. We aimed to explore if cannabis consumption had an effect on hepatic steatosis, in a sample of first-episode (FEP) non-affective psychosis.
A total of 390 patients were evaluated at baseline and after 3 years of initiating the antipsychotic treatment. Anthropometric measurements and liver, lipid, and glycemic parameters were obtained at both time points. All but 6.7% of patients were drug-naïve at entry, and they self-reported their cannabis use at both time points. Liver steatosis and fibrosis were evaluated through validated clinical scores (Fatty Liver Index [FLI], Fibrosis-4 [FIB-4], and NAFLD).
At 3-year follow-up, cannabis users presented significantly lower FLI scores than non-users (F = 13.874; p < .001). Moreover, cannabis users less frequently met the criteria for liver steatosis than non-users (X = 7.97, p = .019). Longitudinally, patients maintaining cannabis consumption after 3 years presented the smallest increment in FLI over time, which was significantly smaller than the increment in FLI presented by discontinuers (p = .022) and never-users (p = .016). No differences were seen in fibrosis scores associated with cannabis.
Cannabis consumption may produce a protective effect against liver steatosis in psychosis, probably through the modulation of antipsychotic-induced weight gain.
肥胖和超重发生率的增加导致非酒精性脂肪性肝病（NAFLD）的发病率增加。最近的证据表明，大麻的摄入对精神病患者的体重增加和相关代谢改变有保护作用。总的来说，由于脂质和血糖代谢紊乱，患者发生脂肪性疾病（如 NAFLD）的风险更高。然而，目前还没有关于大麻对肝脂肪变性可能影响的研究。我们旨在探讨大麻的摄入是否会对首发（FEP）非情感性精神病患者的肝脂肪变性产生影响。
共有 390 名患者在开始抗精神病治疗前和 3 年后进行了评估。在这两个时间点都获得了人体测量学测量值以及肝、脂质和血糖参数。除了 6.7%的患者在进入时是药物-naïve 之外，其余患者都在这两个时间点自我报告了大麻的使用情况。通过验证的临床评分（脂肪肝指数[FLI]、纤维化-4[FIB-4]和非酒精性脂肪性肝病[NAFLD]）评估肝脂肪变性和纤维化。
在 3 年的随访中，大麻使用者的 FLI 评分明显低于非使用者（F=13.874；p<.001）。此外，与非使用者相比，大麻使用者更不容易符合肝脂肪变性的标准（X=7.97，p=0.019）。纵向来看，在 3 年内保持大麻使用的患者在 FLI 方面的时间增长最小，与停用者（p=0.022）和从未使用者（p=0.016）相比，其 FLI 的增长明显更小。与大麻相关的纤维化评分没有差异。
大麻的摄入可能对精神病患者的肝脂肪变性产生保护作用，这可能是通过调节抗精神病药物引起的体重增加。
