Umbricht D S, Pollack S, Kane J M
Hillside Hospital, Psychiatry Research Department, Glen Oaks, N.Y. 11004.
J Clin Psychiatry. 1994 Sep;55 Suppl B:157-60.
To investigate the association of clozapine treatment and weight gain, we studied short- and long-term weight gain, correlation of weight gain with treatment response, and risk factors for weight gain in 82 patients with chronic schizophrenia who received clozapine treatment for up to 90 months.
Weight values were obtained through retrospective chart review. Clozapine was titrated over an average of 3 to 5 weeks up to a dose of 500 to 600 mg/day. Psychopathology was assessed with the Brief Psychiatric Rating Scale and the Clinical Global Impressions scale.
A clinically significant weight gain occurred mostly during the first 6 to 12 months, but continued well into the third year of treatment. Weight gain and treatment response were not correlated, and early weight gain was not a predictor of response. The cumulative incidence of patients becoming substantially overweight exceeded 50%. Being underweight at baseline correlated with maximum amount gained (p = .000), and being overweight at baseline correlated with percentage above ideal weight (p = .006).
Treatment with clozapine is associated with a high incidence of substantial weight gain, posing a potential long-term health risk. Studies are needed of the underlying mechanisms of weight gain, as well as the treatment for this side effect.
为了研究氯氮平治疗与体重增加之间的关联，我们对82例接受氯氮平治疗长达90个月的慢性精神分裂症患者的短期和长期体重增加情况、体重增加与治疗反应的相关性以及体重增加的危险因素进行了研究。
通过回顾性病历审查获取体重值。氯氮平平均在3至5周内滴定至500至600毫克/天的剂量。使用简明精神病评定量表和临床总体印象量表评估精神病理学。
临床上显著的体重增加主要发生在最初的6至12个月，但在治疗的第三年仍持续存在。体重增加与治疗反应不相关，早期体重增加也不是反应的预测指标。患者显著超重的累积发生率超过50%。基线时体重过轻与最大增加量相关（p = .000），基线时超重与高于理想体重的百分比相关（p = .006）。
氯氮平治疗与显著体重增加的高发生率相关，这带来了潜在的长期健康风险。需要对体重增加的潜在机制以及这种副作用的治疗方法进行研究。
