奥氮平导致的血脂变化对精神分裂症患者骨转换生化指标的影响

摘要

Objective To learn the effect of change in serum lipids caused by olanzapine on bone turnover markers in patients with schizophrenia.Methods Eight-four 18 -40 -year-old schizophrenic patients were included.They were divided into 2 groups:44 schizophrenic patients who took olanzapine for at least 6 months ( olanzapine group) and 40 patients who had never take any antipsychotics ( first-episode schizophrenia group ) .The demographic factors and clinical symptoms were recorded.Serum triglyceride (TG), cholesterol (CHOL), high density lipoprotein (HDL), Low density lipoprotein (LDL), osteocalcin (BGP), andβ-CROSSL were measured.Results (1) Compared to those in the first-episode schizophrenic group, BMI, CHOL, LDL,β-CROSSL, and BGP increased, but HDL decreased in olanzapine group ( P <0.05 ) .( 2 ) CHOL and HDL were negatively correlated with β-CROSSL (r=-0.244, -0.246, respectively, P<0.05).CHOL was negatively correlated with BGP (r=-0.315, P<0.01).BGP was positively correlated with β-CROSSL (r =0.461, P <0.01).(3) Multiple stepwise regression showed that the change of β-CROSSL was determined by CHOL and HDL ( R2 C=4.8%, 4.9%) , and the change of BGP was determined by CHOL ( R2 C=8.8%) .Conclusion The change in serum lipids caused by olanzapine closely correlates with bone turnover rate.The change in circulating lipid levels ( mainly CHOL) may affect bone metabolism mainly by changing the bone turnover markers.%目的：探讨非典型抗精神病药奥氮平导致的血脂水平变化对精神分裂症患者骨转换生化指标的影响。方法年龄18～40岁精神分裂症患者84例，其中持续服用奥氮平6个月以上患者44例（奥氮平组），首发未服药患者40例（首发组）。收集患者一般人口学资料，采用阳性和阴性症状（ PANSS）量表评定临床症状，采集患者清晨空腹静脉血5 ml，检测总胆固醇（CHOL）、甘油三酯（TG）、低密度脂蛋白（LDL）、高密度脂蛋白（HDL）、骨钙素（BGP）和β胶原特殊序列（β－CROSSL）水平。结果（1）与首发未服药组相比，奥氮平组患者BMI、CHOL、LDL、BGP、β－CROSSL明显升高，HDL水平降低，差异均有统计学意义（P＜0．05）。（2）相关分析显示： CHOL、HDL均与β－CROSSL成负相关（r值为－0．244、－0．246，P＜0．05）；CHOL与BGP成负相关（r值为－0．315，P＜0．01）；BGP与β－CROSSL之间成正相关（r值为0．461，P＜0．01）；多元逐步回归法分析后显示：CHOL和HDL是影响β－CROSSL代谢的因素（决定系数R2 C分别为4．8％、4．9％）；CHOL是影响BGP代谢的因素（决定系数R2 C为8．8％）。结论奥氮平导致的血脂水平变化与骨转换速率相关，循环中血脂水平（主要是CHOL）变化可能主要通过改变骨形成标志物水平来影响骨代谢。