長期服用奧氮平精神分裂癥患者穩定期認知功能與代謝綜合征的關系

高慧,姚培芬,盛嘉玲,戴晶璟,王衛平,唐偉,張晨

·論著·

長期服用奧氮平精神分裂癥患者穩定期認知功能與代謝綜合征的關系

高慧,姚培芬,盛嘉玲,戴晶璟,王衛平,唐偉,張晨

目的探討伴或不伴代謝綜合征患者認知功能的差異及其影響因素。方法采用《美國國家膽固醇教育項目成人治療組第3次指南》(NCEP-ATPⅢ)診斷標準,將216例長期單藥使用奧氮平治療的精神分裂癥患者分為MS組和非MS組,采用重復性神經心理狀態測驗(RBANS)評估認知功能。結果MS組與非MS組間奧氮平使用時間和劑量差異有統計學意義(P<0.01)。生化指標在兩組間比較結果顯示MS組體質量指數(BMI)、腰圍、空腹血糖(GLU)、三酰甘油(TG)、血壓水平均顯著高于非MS組(P<0.05或P<0.01),而MS組高密度脂蛋白(HDL)水平顯著低于非MS組(P<0.01)。多因素方差分析顯示MS組RBANS測試中即刻記憶、注意、延遲記憶及總分低于非MS組(P<0.01)。多元回歸分析結果顯示RBANS總分與GLU水平呈負相關(t=-2.57,P=0.01)。結論伴MS精神分裂癥患者相比不伴MS患者認知功能更差,高血糖可能參與了認知缺損的發生機制并提示了缺損嚴重程度。

奧氮平； 認知功能； 精神分裂癥； 代謝綜合征； 血糖

Abstract：Objective：To investigate the difference of cognitive function in schizophrenia patients with or without metabolic syndrome(MS) and analyze its influence factors.Method：Based on the diagnostic criteria of National Cholesterol Education Program's Adult Treatment Panel III (NCEP-ATPⅢ),a total of 216 schizophrenia patients with long-term olanzapine monotreatment were divided into MS and non-MS groups.Repeatable battery for the assessment of neuropsychological status(RBANS) was used to evaluate the cognitive function.Results：There were significant differences in duration and dosage of olanzapine treatment between the MS and non-MS groups (P<0.01).Body mass index,levels of waist circumference,fasting glucose(GLU),triglyceride(TG) and blood pressure in MS group were significantly higher than those in non-MS group (P<0.05 orP<0.01 ).HDL level in MS group was significantly lower than that in non-MS group (P<0.01).ANCOVA analysis showed that immediate memory,attention,delayed memory and total score in RBANS were lower in MS group than those in non-MS group (P<0.01).The results of multiple linear regression analysis showed that the severity of cognitive function in schizophrenia patients was negatively correlated with GLU level (t=-2.57,P=0.01).Conclusion：Schizophrenia patients with MS have worse cognitive performance than those without MS,and high level of glucose may be involved in the mechanism of cognitive impairment and imply its severity.

Keywords： olanzapine; cognitive function; schizophrenia; metabolic syndrome; glucose

臨床實踐發現長期使用非典型抗精神病藥(AAP)極易破壞體內糖脂代謝平衡,引起體質量增加、腹內脂肪堆積、高血糖、高三酰甘油血癥等繼發性代謝不良反應[1]。最近美國糖尿病協會和美國精神病協會已發表了關于AAP與糖尿病相關性的共識報告[1]。同時,越來越多的研究發現精神疾病患者代謝綜合征的出現常常伴隨認知缺損。Lindenmayer等[2]發現出現代謝綜合征的精神分裂癥患者認知缺損較無代謝綜合征的患者更為顯著,在工作記憶方面尤為明顯。CATIE-AD研究指出經過一年隨訪,服用AAP的阿爾茲海默病患者認知缺陷較服用安慰劑的患者更為嚴重,提示長期使用AAP可造成認知損害[3]。以往臨床研究也顯示小鼠連續系統注射AAP可導致學習和記憶損害[4]。因此,AAP引起代謝紊亂和認知損害之間可能具有內在聯系。奧氮平是AAP代表藥物,對精神分裂癥的陽性和陰性癥狀具有良好的療效,而且錐體外系不良反應弱,故已廣泛應用于臨床。……