Ethnic heterogeneity in glucoregulatory function during treatment with atypical antipsychotics in patients with schizophrenia
Ethnic heterogeneity in glucoregulatory function during treatment with atypical antipsychotics in patients with schizophrenia
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DOI：
10.1016/j.jpsychires.2008.01.004
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发表时间：
2008-10-01
影响因子：
4.8
通讯作者：
Bergman, Richard N.
中科院分区：
文献类型：
--
作者：
Ader, Marilyn;Garvey, W. Timothy;Bergman, Richard N.
目的：非典型抗精神病药物可导致体重增加，并与糖尿病风险增加有关，但其增加疾病风险的相关影响因素尚不清楚。方法：我们进行了一项为期6个月的随机双盲研究，评价利培酮和奥氮平对精神分裂症患者的疗效。在基线、第6周和第24周，我们量化：(1)DEXA测定总体肥胖，(2)腹部CT测定内脏肥胖，(3)胰岛素敏感性(SI)和(4)静脉糖耐量试验测定胰腺功能(“倾向指数”，DI)。结果：基线时，体重指数超重或肥胖的组(利培酮：28.4+/-5.4，奥氮平：30.6+/-7.0 kg/m(2))。两种药物都会导致体重增加(p<；0.004)。奥氮平在6周时增加了总肥胖率(p=0.0006)，在24周时两种治疗方法都增加了肥胖率(p<；0.003)。奥氮平和利培酮增加内脏肥胖症24周(p<；0.003)。虽然利培酮有下降的趋势，但S-1的病情没有明显恶化。鉴于已知的肥胖和硅的种族差异，我们对非裔美国人和西班牙裔受试者进行了二次分析。在这一亚组中，奥氮平增加了总肥胖率和内脏肥胖率(p<；0.02)；利培酮没有观察到增加。两种处理的S-1都有温和的下降趋势。到24周时，奥氮平治疗的受试者表现出DI减少(p=0.033)，这表明胰腺对胰岛素抵抗的代偿不足。这是第一项对精神病患者进行的前瞻性研究，量化了增加糖尿病风险的多种代谢过程中的抗精神病药物效果。结果表明，少数民族可能对抗精神病药物引起的糖调节并发症有更大的易感性。(C)2008爱思唯尔有限公司。保留所有权利。
Objective: Atypical antipsychotics induce weight gain and are linked to increased diabetes risk, but their relative impact oil factors that elevate disease risk are unknown.Methods: We performed a 6-month, randomized, double-blind study to evaluate the effects of risperidone and olanzapine in patients with schizophrenia. At baseline and weeks 6 and 24, we quantified: (1) total adiposity by DEXA, (2) visceral adiposity by abdominal CT, and (3) insulin sensitivity (SI) and (4) pancreatic function ("disposition index", DI) by intravenous glucose tolerance test.Results: At baseline, groups (risperidone: n = 28; olanzapine: n = 31) were overweight or obese by body mass index(risperidone: 28.4 +/- 5.4, olanzapine: 30.6 +/- 7.0 kg/m(2)). Both drugs induced weight gain (p < 0.004). Total adiposity was increased by olanzapine at 6 weeks (p = 0.0006) and by both treatments at 24 weeks (p < 0.003). Visceral adiposity was increased by olanzapine and risperidone by 24 weeks (p < 0.003). S-1, did not deteriorate appreciably, although a downward trend was observed with risperidone. Given known ethnic differences in adiposity and Si, we performed secondary analysis in African American and Hispanic subjects. In this subset, olanzapine expanded both total and visceral adiposity (p < 0.02); no increase was observed with risperidone. There were modest downward trends for S-1 with both treatments. By week 24, olanzapine-treated subjects exhibited diminished DI (p = 0.033), indicating inadequate pancreatic compensation for insulin resistance.Conclusions. This is the first prospective Study in psychiatric patients that quantified antipsychotic effects oil the Multiple metabolic processes that increase diabetes risk. Results indicate that ethnic minorities may have greater susceptibility to antipsychotic-induced glucoregulatory complications. (c) 2008 Elsevier Ltd. All rights reserved.