帕利哌酮与齐拉西酮替代奥氮平所致代谢综合征的对照研究

摘要

Objective:To investigate effects of Paliperidone and Ziprasidone on metabolic syndrome caused by Olanzapine. Methods:64 schizophrenic patients with metabolic syndrome caused by Olanzapine were randomly assigned in Paliperidone group (32 cases) and Ziprasidone group (32 cases), wherein Paliperidone and Ziprasidone were used to replace Olanzapine. The differences in BMI, HOMA-IR, WC, GLU, BP, TG and HDL, and PANSS, CGI-S and TESS scores before and 1, 2, 4, 8, and 12 weeks after the drug change were compared. Results:After the drug change, BMI, HOMA-IR, WC, GLU, BP, TG of the two groups were signif-icantly reduced (P<0. 01), and the insulin resistance level of Paliperidone group 4, 8, and 12 weeks after the drug change was obvi-ously lower than that of Ziprasidone group (P<0. 05 or P<0. 01). The PANSS total score of Paliperidone group 1 week after the drug change and Ziprasidone group obviously increased;however, there were no differences in the PANSS total score before and 4, 8, and 12 weeks after the drug change for Paliperidone group. The adverse reaction rates were 37. 5% in Paliperidone group and 43. 75% in Ziprasidone group. Conclusions:Paliperidone and Ziprasidone could reduce metabolic syndrome caused by Olanzapine, and the effects of Paliperidone are slightly better in reducing insulin resistance and controlling psychotic symptoms, therefore it is worth trying in clini-cal practice.%目的：：探讨帕利哌酮缓释片与齐拉西酮对奥氮平所致精神病患者代谢综合征的影响。方法：将64例因服用奥氮平所致代谢综合征的精神分裂症患者随机分成两组,每组32例,然后一组替换成帕利哌酮(帕利哌酮组),另一组替换成齐拉西酮(齐拉西酮组),对比两组患者换药前、换药后第1、2、4、8、12周PANSS、CGI-S、TESS(副反应量表),BMI、HOMA-IR、腰围、空腹血糖、血压、甘油三酯和高密度脂蛋白的差异。结果：两组患者换药后代谢综合征指标BMI、HOMA-IR,腰围,空腹血糖,血压,甘油三酯均明显下降(P<0.01),第4、8、12周帕利哌酮组胰岛素抵抗水平显著低于齐拉西酮组(P<0.05 or P<0.01)。此外,帕利哌酮组PANSS总分在第1周明显升高(P<0.01),第4,8,12周与换药前无差异(P>0.05),而齐拉西酮组均明显升高(P<0.01)。帕利哌酮组不良反应率为37.5%,而齐拉西酮为43.75%。结论：帕利哌酮缓释片与齐拉西酮均能减轻奥氮平所致的代谢综合征,但帕利哌酮缓释片在降低胰岛素抵抗方面的效果要优于齐拉西酮,同时帕利哌酮缓释片在降低奥氮平所致的代谢综合征的同时,还能很好地控制患者的精神病性症状值得在临床实践中尝试。