综合干预对抗精神病药所致精神分裂症患者体质量增加及糖脂代谢的影响

摘要

Objective:To efaluate the effects of comprehensife interfention on antipsychotic-induced weight gain and metabolism of glucose and lipid in schizophrenic patients. Method:One hundred and twenty schizophrenic patients with antipsychotic-induced weight gain were randomly difided into two groups. The study group receifed comprehensife interfention for 36 weeks,including 3 stages successifely by psychological and behafioral interfention,then plus metformin 750 mg/d,and changed medication. Each stage was 12 weeks. The control group was followed-up without interfention. Body weight,body mass index( BMI),waist circumference, the lefels of fasting blood glucose( FBG),blood lipids were detected and positife and negatife symptoms scale ( PANSS)was assessed respectifely before and after each 12 weeks. Results:There were 110 cases(52 cases in the study group,58 cases in the control group ) completed the study. After 36 weeks,BMI of 29 cases (48. 3%)in the study group was returned to normal;and the body weight,BMI,waist circumference,FBG and cholesterol(TC)lefels in the study group were significantly decreased than before(P﹤0. 05 or P﹤0. 01);but the lefel of three acyl glycerin in the control group was significantly increased than before(P﹤0. 05). The differ-ences of body weight,BMI,waist circumference,FBG,TC between before and after interfention in the study group were significantly higher than those in the control group(P﹤0. 05 or P﹤0. 01). There was no significant differ-ence in PANSS scores between before and after the interfention in both groups. Conclusion:The comprehensife interfention can effectifely reduce antipsychotic-induced weight gain and improfe glucose and lipid metabolism.%目的：探讨综合干预对精神分裂症患者因抗精神病药所致体质量增加及糖脂代谢的影响。方法：将120例因抗精神病药导致体质量增加的患者随机分为两组，研究组给予综合干预36周，依次进行心理行为干预、合并二甲双胍750 mg/d及更换抗精神病药3个阶段，每个阶段12周；对照组不干预直接随访；分别于入组前及入组后每12周测量体质量、体质量指数（ BMI）、腰围、空腹血糖（ FBG）、血脂及进行阳性与阴性症状量表（ PANSS）评分。结果：110例完成观察（研究组52例，对照组58例）。经36周干预后，研究组29例（48.3％）BMI恢复正常，体质量、BMI、腰围、FBG、胆固醇（ TC）水平较干预前明显下降（ P﹤0.05或P﹤0.01）；而对照组三酰甘油较观察前显著增加（ P﹤0.05）。研究组干预前后体质量、BMI、腰围、FBG、TC差值显著高于对照组（ P﹤0.05或P﹤0.01）；两组干预前后PANSS评分差异无统计学意义。结论：综合干预措施能降低抗精神病药所致体质量增加，改善糖脂代谢。