精神分裂患者使用Olanzapine與Risperidone之代謝副作用評估

【前言】新型的非典型抗精神分裂症藥物(antipsychotics)，如olanzapine、risperidone、clozapine及quetiapine等，近年來已常被作為精神分裂症的第一線治療用藥。近來愈來愈多的報告顯示，服用這些新型抗精神分裂症藥物，容易導致體重增加，引發代謝上的異常如：血中三酸甘油酯增加及血糖上升。體重增加、血脂肪及血糖的調控異常，皆是導致心血管疾病的危險因子。使用這些新型的非典型抗精神分裂症用藥，評估治療成效之餘，對於代謝方面所產生的副作用，為本研究之主要目的。【研究目的】台南市立醫院最常用的兩種抗精神分裂症藥物olanzapine及risperidone，比較兩者在病患接受治療期間，對於血糖及血脂肪的影響。【研究方法】自2004年1月起至2004年12月止，台南市立醫院精神科使用非典型抗精神病藥risperidone與olanzapine之門診患者。納入標準：長期服用olanzapine或risperidone大於6個月以上的患者。排除標準：服藥初期病患即有糖尿病、高血脂症，合併服用其他影響血糖或血脂肪的藥物，如：α-、β-blocker、steroid、等。本研究採病歷回顧審閱方式，記錄與分析患者服用olanzapine或risperidone期間，臨床及生化檢驗數據變化。比較與評估的參數包括：性別、年齡、疾病的發生及追蹤時間、體重、空腹血糖、膽固醇、三酸甘油酯。【結果】 Risperidone明顯的增加空腹血糖值(15.5%)、膽固醇(14.9%)及三酸甘油酯(53.8%)，而olanzapine只有意義的增加三酸甘油酯(45.2%)。但上述的平均空腹血糖、膽固醇及三酸甘油酯的數值，皆在正常值範圍內。

關鍵字

代謝性副作用； risperidone ； olanzapine

並列摘要

Abstract Background: Atypical antipsychotics offer a profile of superior safety compared with older, conventional antipsychotic agents in terms of extrapyramidal symptoms. However, the newer agents have been associated with metabolic side effects including hyperglycemia, body weight gain, diabetes mellitus, and abnormal blood lipids. Abnormalities in peripheral glucose regulation and type Ⅱdiabetes mellitus can occur more commonly in schizophrenic patients. The increased body weight and abdominal adiposity can also decrease skeletal insulin sensitivity and contribute to hyperglycemia. Obviously, patients undergoing treatment with atypical antipsychotic agents may also have more risk factors for cardiovascular diseases. A limited number of comparative studies demonstrate the different metabolic side effects of the newer atypical antipsychotics. Risperidone and olanzapine are the most common atypical antipsychotic agents used in our organization. We conducted a retrospective clinical study to evaluate the adverse metabolic effects of olanzapine and risperidone. Study Method: Patients who were diagnosed with schizophrenia and had taken olanzapine or risperidone more than 6 months were included. We excluded those who took other drugs known to affect glucose metabolism (including α, β adrenergic blockers, thiazide diuretics, corticosteriods, phenytoin, and volproate), and those who were diagnosed with diabetes mellitus and hyperlipidemia at the initial time of study. We reviewed and analyzed the changes of blood lipids and fasting blood glucose levels noted in the medical records. We used SPSS 12.0 for Windows for all analysis. The levels of blood lipids and fasting sugars were examined using the Mann-Whitney U test, comparing the changes before and after medication with olanzapine and risperidone. Wilcoxon signed-rank test was used to examine the differences in the metabolic side effects between these 2 groups. Result : The results of this study revealed that risperidone had the potential to raise fasting blood glucose, cholesterol, and triglyceride levels, and olanzapine only significantly affected triglyceride metabolism during the medication period. However, all mean blood lipids and fasting blood glucose levels remained within normal clinical range.