Metabolic effects of olanzapine in patients with newly diagnosed psychosis.
Metabolic effects of olanzapine in patients with newly diagnosed psychosis.
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DOI：
10.1097/jcp.0b013e31820fcea3
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发表时间：
2011-04
影响因子：
2.9
通讯作者：
Kirkpatrick B
中科院分区：
文献类型：
--
作者：
Fernandez-Egea E;Miller B;Garcia-Rizo C;Bernardo M;Kirkpatrick B
抗精神病药物与糖尿病风险增加有关。此前的研究还发现，精神分裂症先证者的亲属患 2 型糖尿病的风险增加。本研究的目的是探讨奥氮平对一组新诊断精神病且很少或不接触抗精神病药物的患者的代谢不良影响。新诊断的精神病患者 (n = 30) 参加了为期 16 周的奥氮平开放试验。在基线和每隔 4 周测量一次体重指数、空腹血糖、糖化血红蛋白、空腹胰岛素、IL-6 和空腹血脂。随着时间的推移，空腹血糖 (P = 0.043)、体重 (P < 0.001)、体重指数 (P < 0.001)、总胆固醇 (P = 0.005)、甘油三酯 (P = 0.003) 和低密度脂蛋白 (P = 0.013) 呈显着线性增加，但血红蛋白 A1c (P = 0.691) 没有显着增加。空腹胰岛素（P = 0.690）、IL-6（P = 0.877）或高密度脂蛋白（P = 0.446）。基线 IL-6 异常是总胆固醇 (P < 0.01) 和低密度脂蛋白 (P < 0.01) 大幅增加的显着预测因子。除此之外，父母的 2 型糖尿病史和基线 IL-6 都无法预测代谢指标的变化。对于既往未接受抗精神病药物治疗的患者，可以在治疗早期检测到奥氮平治疗后代谢指标的变化。空腹胰岛素没有变化表明胰岛细胞无法补偿空腹血糖的增加。
Antipsychotic medications are associated with an increased risk of diabetes. Previous studies have also found an increased risk of type 2 diabetes mellitus in the relatives of schizophrenia probands. The aim of this study was to explore the metabolic adverse effects of olanzapine in a cohort of patients with newly diagnosed psychosis and minimal or no exposure to antipsychotics. Patients with newly diagnosed psychosis (n = 30) were enrolled in a 16-week open trial of olanzapine. Body mass index, fasting glucose, hemoglobin A1c, fasting insulin, IL-6, and a fasting lipid profile were measured at baseline and at 4-week intervals. There was a significant, linear increase over time in fasting glucose (P = 0.043), weight (P < 0.001), body mass index (P < 0.001), total cholesterol (P = 0.005), triglycerides (P = 0.003), and low-density lipoprotein (P = 0.013), but not hemoglobin A1c (P = 0.691), fasting insulin (P = 0.690), IL-6 (P = 0.877), or high-density lipoprotein (P = 0.446). An abnormal baseline IL-6 was a significant predictor of a greater increase in both total cholesterol (P < 0.01) and low-density lipoprotein (P < 0.01). Otherwise, neither parental history of type 2 diabetes mellitus nor baseline IL-6 predicted changes in metabolic measures. Changes in metabolic measures with olanzapine treatment can be detected early in the treatment of patients who are previously antipsychotic naive. The absence of a change in fasting insulin suggests a failure of pancreatic islet cells to compensate for the increase in fasting glucose.