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初治未用药的早期治疗无反应型精神分裂症患者疗效与常见代谢参数之间的关系:一项回顾性研究

Relationship between efficacy and common metabolic parameters in first-treatment drug-naïve patients with early non-response schizophrenia: a retrospective study.

作者信息

Zhu Junhong, Wu Jiajia, Liu Xuebing, Ma Jun

机构信息

Department of Psychiatry, Wuhan Mental Health Center, No. 89, Gongnongbing Road, Jiang'an District, Wuhan, Hubei, China.

Wuhan Hospital for Psychotherapy, No. 89, Gongnongbing Road, Jiang'an District, Wuhan, Hubei, China.

出版信息

Ann Gen Psychiatry. 2023 Feb 17;22(1):6. doi: 10.1186/s12991-023-00436-3.

Abstract

BACKGROUND

Comorbid metabolic disorders in patients with schizophrenia are very common. Patients with schizophrenia who respond to therapy early are often strongly predictive of better treatment outcomes. However, the differences in short-term metabolic markers between early responders and early non-responders in schizophrenia are unclear.

METHODS

143 first-treatment drug-naïve schizophrenia patients were included in this study and were given a single antipsychotic medication for 6 weeks after admission. After 2 weeks, the sample was divided into an early response group and an early non-response group based on psychopathological changes. For the study endpoints, we depicted the change curves of psychopathology in both subgroups and compared the differences between the two groups in terms of remission rates and multiple metabolic parameters.

RESULTS

The early non-response had 73 cases (51.05%) in the 2nd week. In the 6th week, the remission rate was significantly higher in the early response group than in the early non-response group (30,42.86% vs. 8,10.96%); the body weight, body mass index, blood creatinine, blood uric acid, total cholesterol, triglyceride, low-density lipoprotein, fasting blood glucose, and prolactin of the enrolled samples were significantly increased, and high-density lipoprotein was significantly decreased. ANOVAs revealed a significant effect of treatment time on abdominal circumference, blood uric acid, total cholesterol, triglyceride, high-density lipoprotein, low-density lipoprotein, fasting blood glucose and prolactin, and a significant negative effect of early non-response to treatment on abdominal circumference, blood creatinine, triglyceride, fasting blood glucose.

CONCLUSIONS

Schizophrenia patients with early non-response had lower rates of short-term remission and more extensive and severe abnormal metabolic indicators. In clinical practice, patients with early non-response should be given a targeted management strategy, antipsychotic drugs should be switched on time, and active and effective interventions for their metabolic disorders should be given.

摘要

背景

精神分裂症患者共病代谢紊乱非常常见。早期对治疗有反应的精神分裂症患者往往强烈预示着更好的治疗结果。然而,精神分裂症早期反应者和早期无反应者之间短期代谢标志物的差异尚不清楚。

方法

本研究纳入143例首次治疗且未使用过药物的精神分裂症患者,入院后给予单一抗精神病药物治疗6周。2周后,根据精神病理学变化将样本分为早期反应组和早期无反应组。对于研究终点,我们描绘了两个亚组的精神病理学变化曲线,并比较了两组在缓解率和多个代谢参数方面的差异。

结果

第2周时早期无反应者有73例(51.05%)。第6周时,早期反应组的缓解率显著高于早期无反应组(30例,42.86%对8例,10.96%);纳入样本的体重、体重指数、血肌酐、血尿酸、总胆固醇、甘油三酯、低密度脂蛋白、空腹血糖和催乳素显著升高,高密度脂蛋白显著降低。方差分析显示治疗时间对腹围、血尿酸、总胆固醇、甘油三酯高密度脂蛋白、低密度脂蛋白、空腹血糖和催乳素有显著影响,早期治疗无反应对腹围、血肌酐、甘油三酯、空腹血糖有显著负面影响。

结论

早期无反应的精神分裂症患者短期缓解率较低,代谢指标异常更广泛、更严重。在临床实践中,应对早期无反应的患者采取针对性管理策略,及时更换抗精神病药物,并对其代谢紊乱给予积极有效的干预。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c11d/9936715/f19e8ee0024b/12991_2023_436_Fig1_HTML.jpg

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