精神分裂症患者服用克慮平導致的肥胖與心血管疾病相關危險因子之探討及透過減重飲食與規律性活動介入對其改善效果之研究

精神分裂症的盛行率約1%，該疾病主要是精神及社交功能的障礙，這類病患必須長期靠藥物控制病情；第二代精神病藥物中的克慮平(clozapine)不只改善精神分裂症患者的正向症狀也可以改善負向症狀及認知功能；許多研究證明克慮平是所有抗精神病藥物中會使患者體重及身體質量指數(BMI)增加最多的藥物。一般人均認為因服用抗精神病藥物導致肥胖的精神分裂症病人，其體位及生理變化應該與一般非精神病的肥胖者是相同的，但研究結果發現，服用克慮平導致的肥胖精神分裂症病人其腰臀比、血液中胰島素濃度及胰島素阻抗係數(HOMA index) 都明顯的比一般非精神病的肥胖者高，同時也發現該類病患其胰島素的敏感度、總膽固醇、低密度脂蛋白膽固醇、類胰島素生長因子-1(IGF-1)等濃度、總膽固醇 /高密度脂蛋白膽固醇(TC/HDL-C)、低密度脂蛋白膽固醇/高密度脂蛋白膽固醇 (LDL-C/HDL-C)及類胰島素生長因子-1/類胰島素生長因子結合蛋白第三型的比值 (IGF-1/IGFBP-3 molar ratio)也都明顯的比一般非精神病的肥胖者低，這些偏高及偏低的數值均是造成心血管疾病的危險因子。為降低服用克慮平導致的肥胖精神分裂症病人罹患心血管疾病之危險，因此透過減重飲食及規律性活動兩種方式同時介入，為病患進行體重控制並分析其心血管疾病的危險因子的改善情形，結果發現：經由減重飲食及規律性活動同時介入後，可以明顯的降低患者的體重、身體質量指數、體脂肪百分比、腰圍及臀圍，除此之外還可以減少患者體內三酸甘油酯，胰島素，類胰島素生長因子結合蛋白第三型等濃度及並增加類胰島素生長因子-1/類胰島素生長因子結合蛋白第三型的比值，明顯的降低心血管疾病的危險因子，因此要減少此類服用克慮平導致的肥胖精神分裂症患者體內心血管疾病之危險因子-透過長期使用減重飲食及規律性活動兩者同時介入，是一種既安全又有效，經濟又實惠的好方法。

關鍵字

精神分裂症；克慮平；肥胖；飲食；身體活動

並列摘要

Schizophrenia has a prevalence of 1 percent in all cultures and is equally common in men and women. It is a devastating mental illness that impairs mental and social functioning. Clozapine is effective in treating not only the positive symptoms of schizophrenia, but also in reducing negative symptoms and cognitive deficits. Several studies have reported significant weight gain with clozapine and the largest weight gains seen with antipsychotic drug and had a significantly higher mean BMI value and rate of obesity than patients treated with other SGAs. Obese patients with schizophrenia being treated with clozapine (OSC) and non-psychiatric obese (OB) are often assumed to share the same physiological changes in obesity. In fact, the obese patients with schizophrenia being treated with clozapine was different from non-psychiatric obese in physiological change. Although the anthropometric parameters in the OB and OSC groups were similar, in the OSC group the waist-to-hip ratio (WHR), insulin levels and HOMA index were significantly higher, while insulin sensitivity, cholesterol, low-density lipoprotein (LDL) cholesterol, TC/HDL-C, LDL-C/HDL-C, IGF-1 and IGF-1/IGFBP-3 molar ratio were lower, than those of the OB group. Significant weight gain can lead to health complications such as cardiovascular disease, hypertension, dyslipidemia, stroke, gallbladder disease, osteoarthritis, sleep apnea, respiratory problems, certain cancers, and type 2 diabetes. Compliance with prescribed antipsychotic medication is low and weight gain contributes to psychotropic non-compliance. The intervention program of dietary control and regular physical activity in obese patients with schizophrenia being treated with clozapine can showed a significant decrease in body weight, BMI, body fat percentage, and waist and hip girths. In addition, participating patients showed improved metabolic profiles of triglyceride, insulin, IGFBP-3 levels, and the IGF-1 to IGFBP3 molar ratio. In conclusion, the obese patients with schizophrenia being treated with clozapine was different from non-psychiatric obese in physiological 3 change. The obese patients with schizophrenia being treated with clozapine group was characterized by impaired glucose–insulin homeostasis, abnormal lipid profiles and hormonal changes in the GH-IGF-IGFBP axis and in leptin. By way of the program of dietary control and regular physical activity can significantly reduce body weight and improve metabolic profiles of insulin, triglyceride, and IGFBP-3 among obese inpatients taking clozapine for the treatment of schizophrenia.

並列關鍵字

schizophrenia ； clozapine ； obesity ； diet ； physical activity

參考文獻

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精神分裂症患者服用克慮平導致的肥胖與心血管疾病相關危險因子之探討及透過減重飲食與規律性活動介入對其改善效果之研究

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