五种常用二代抗精神病药物对首发精神分裂症患者泌乳素的近期影响

摘要

目的：探讨目前临床常用的5种二代抗精神病药物对首发精神分裂症患者血清泌乳素（prolactin， PRL）水平的近期影响。方法250例首发精神分裂症患者随机分为5组，分别采用利培酮、奥氮平、帕利哌酮、喹硫平、齐拉西酮治疗6周，检测基线（入组时）和治疗每周末血清泌乳素水平，并在基线和治疗第6周末采用阳性与阴性症状量表（positive and negative symptom scale，PANSS）和副反应量表（treatment emergent symptom scale，TESS）评估各药物疗效与安全性。结果患者泌乳素水平经重复测量方差分析示，时间因素主效应、分组因素主效应和时间与分组的交互效应均具有统计学意义（均P<0.01）。其中第1周末时，利培酮组泌乳素水平均高于另外4组（P<0.05）；第2、3、4、5周末时，利培酮组和奥氮平组泌乳素水平均高于其他3组（P<0.05）；第6周末，利培酮组、奥氮平组和帕利哌酮组均高于其他2组（P<0.05），并且利培酮组和奥氮平组高于帕利哌酮组（P<0.05）。治疗前后PANSS量表的变化值在5组间有统计学差异（P<0.05），不良反应发生率无统计学差异（P>0.05）。结论抗精神病药物治疗使患者泌乳素水平逐渐增高；不同二代抗精神病药物对泌乳素的近期影响不同，利培酮和奥氮平在治疗早期就能明显升高泌乳素水平。%Objective To explore the short term effects of five second-generation antipsychotics on the serum pro⁃lactin levels of first-episode schizophrenia patients. Methods Two hundred fifty first-episode schizophrenia patients were randomly divided into five groups and were then treated with risperidone, olanzapine, paliperidone, quetiapine or ziprasidone, respectively. The serum prolactin were tested at baseline, and every week following initiation of treatment. The positive and negative symptom scale (PANSS) and the treatment emergent symptom scale (TESS) were used to evalu⁃ate the effect and side effect of treatment. Results Repeated measure ANOVA for serum prolactin showed that the main effects of time, the main effect of group, and the interactive effect of time and group were significant (all P<0.01). At the first week, the serum prolactin level of risperidone group was higher than all the other four groups (P<0.05). At the sec⁃ond, third, fourth and fifth week, the serum prolactin level of risperidone group and olanzapine group was higher than the other three groups (P<0.05). At the end of the sixth week, the serum prolactin level of risperidone group, olanzapine group and paliperidone group was higher than the quetiapine and ziprasidone groups (P<0.05). But serum prolactin level of risperidone group and olanzapine group was higher than that of paliperidone group (P<0.05). The changes of PANSS before and after treatment were significantly different among groups (P<0.05). However, the incidence of the side effects was not significantly different among groups (P>0.05). Conclusion The level of serum prolactin gradually increases in schizophrenia patients receiving treatment of antipsychotics. The short term effects of different second generation antipsy⁃chotics on serum prolactin vary differently. Risperidol and olanzapine result in the elevation of serum prolactin level in the early period of treatment.