Clozapine Response in Schizophrenia and Hematological Changes.
Clozapine Response in Schizophrenia and Hematological Changes.
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DOI：
10.1097/jcp.0000000000001329
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发表时间：
2021
影响因子：
2.9
通讯作者：
MacCabe J
中科院分区：
文献类型：
--
作者：
Blackman G;Lisshammar JEL;Zafar R;Pollak TA;Pritchard M;Cullen AE;Rogers J;Carter B;Griffiths K;Nour M;David AS;McGuire P;Stewart R;MacCabe J
氯氮平是治疗难治性精神分裂症的唯一有效药物;然而，其作用机制仍不清楚。本研究探讨其有效性是否与氯氮平开始后血液学指标的变化有关。英国最大的精神健康信托基金会从电子病历中确定了2007年1月至2014年12月期间开始服用氯氮平的难治性精神分裂症患者。这些患者的血液学数据来自监测登记处。白色血细胞，中性粒细胞和血小板计数进行了评估，在基线和早期阶段的氯氮平治疗。氯氮平在3个月时的反应被定义为在7分临床总体印象改善（CGI-I）子量表上“很大”或“非常大”的改善。在全部样本（n = 188）中，氯氮平开始与白色血细胞、中性粒细胞和血小板计数的显著一过性升高（在第3 - 4周达到峰值）相关（P < 0.001）。有112例（59.6%）患者对治疗有应答;然而，基线时评估的血液学因素或这些因素的变化均与治疗应答无直接相关性。氯氮平治疗与治疗第一个月期间的一过性血液学变化相关;然而，没有证据表明这些变化与治疗反应相关。
Clozapine is the only effective medication for treatment-resistant schizophrenia; however, its mechanism of action remains unclear. The present study explored whether its effectiveness is related to changes in hematological measures after clozapine initiation. Patients with treatment-resistant schizophrenia commenced on clozapine between January 2007 and December 2014 by the United Kingdom’s largest mental health trust were identified from electronic patient records. Hematological data from these patients were obtained from a monitoring registry. White blood cell, neutrophil, and platelet count were assessed at baseline and during the early phase of clozapine treatment. Clozapine response at 3 months was defined as “much,” or “very much” improved on the seven-point Clinical Global Impression—Improvement (CGI-I) subscale. In the total sample (n = 188), clozapine initiation was associated with a significant transient increase (peaking in weeks 3 to 4) in white blood cell, neutrophil, and platelet count (P < 0.001). There were 112 (59.6%) patients that responded to treatment; however, none of the hematological factors assessed at baseline, nor changes in these factors, were directly associated with treatment response. Clozapine treatment is associated with transient hematological changes during the first month of treatment; however, there was no evidence that these were related to the therapeutic response.