摘要
目的 探讨利培酮和奎硫平治疗对女性精神分裂症患者生殖激素和骨密度及体质量的影响及其相互关系.方法 共纳入首次发病女性精神分裂症患者80例,采用随机数字表法随机分为利培酮组（n=40）和奎硫平组（n=40）,分别采用利培酮和奎硫平治疗12个月,于治疗基线和第6、12个月末测定体质量指数和血清促卵泡激素、黄体生成素、雌二醇、睾酮、孕酮、催乳素水平;测量腰椎2-4和左侧股骨颈3个位点的骨密度.结果 （1）治疗第12个月末,利培酮组和奎硫平组腰椎骨密度分别为（0.97 ±0.09）、（1.03±0.11） g/cm^2,差异有统计学意义（F =2.560,P=0.023）.（2）治疗第6、12个月末,利培酮组催乳素浓度分别为（92.4±37.5）、（84.0±42.1）nmol/L,奎硫平组分别为（25.5±8.8）、（27.4 ±6.1）nmol/L,相同时间点比较差异有统计学意义（F=51.174,P＜0.01;F =48.320,P＜0.01）;治疗第6、12个月末,利培酮组雌二醇浓度分别为（146.2±103.2）、（135.8±167.2） pmol/L,奎硫平组分别为（239.4±179.3）、（246.4±184.6） pmol/L,相同时间点比较差异有统计学意义（F =44.325,P＜0.01;F=43.170,P＜0.01）;治疗第6、12个月末利培酮组孕酮浓度分别为（7.2±6.5）、（7.2±5.2）nmol/L,奎硫平组分别为（8.9±6.9）、（8.0±7.2）nmol/L,相同时间点比较差异有统计学意义（F =7.454,P=0.026;F =9.573,P=0.036）.（3）治疗第6、12个月末利培酮组体质量指数分别为（25.73±2.77）、（26.14 ±3.30）kg/m^2,奎硫平组分别为（26.04±3.12）、（26.32±3.48） kg/m^2,相同时间点比较差异无统计学意义（F =0.419,P=0.685;F =0.216,P=0.823）.（4）治疗第12个月末,利培酮组腰椎骨密度变化率与催乳素变化率呈负相关（r=-0.62,P=0.023）,与雌二醇变化率呈正相关（r =0.46,P=0.044）,与体质量指数变化率呈正相关（r=0.58,P=0.035）,与孕酮变化率无相关性（r =0.26,P=0.091）;奎硫平组腰椎骨密度变化率与体质量指数变化率呈正相关（r=0.52,P=0.041）,与催乳素、雌二醇、孕酮变化率无相关性.结论 利培酮和奎硫平治疗对血清催乳素、雌激素、孕酮、腰椎骨密度影响不同,对体质量影响相似,腰椎骨密度与催乳素、雌二醇、体质量相关.
Objective The main goal of this study was to assess the long-term effect of risperidone and quetiapine on reproductive hormone levels,bone mineral density and body mass index in first-episode female schizophrenia population.Methods Eighty patients in first-episode reproductive female schizophrenia were randomly assigned to treat with risperidone （n =40） or quetiapine （n =40） and followed 12 months.Reproductive hormone levels and body mass index were measured at baseline,6 months,12 months,and the femur,lumbar spine bone mineral density measured by using Dual energy X-ray absorptiometry.Results （1）At the end of 12th month,lumbar vertebra bone density in risperidone group and quetiapine group was （0.97 ± 0.09） g/cm^2 and （1.03 ± 0.11） g/cm^2,respectively （F =2.560,P =0.023）.（2） At the end of 6th,12th month,prolactin level in risperidone group was （92.4 ± 37.5） nmol/L and （84.0 ± 42.1） nmol/L,while （25.5 ± 8.8） nmol/L and（27.4 ± 6.1） nmol/L respectively in quetiapine group,and the difference between two groups was statistically significant （F =51.174,P ＜ 0.01 ; F =48.320,P ＜0.01） ; Estradiol level was （146.2 ± 103.2） pmol/L and（135.8 ± 167.2） pmol/L in risperidone group,while （239.4 ± 179.3） pmol/L and（246.4 ± 184.6） pmol/L in quetiapine group（F =44.325,P ＜0.01 ; F =43.170,P ＜ 0.01）,and progesterone was （7.2 ± 6.5） nmol/L and （7.2 ± 5.2） nmol/L in risperidone group,while （8.9 ± 6.9） nmol/L and（8.0 ± 7.2） nmol/L in quetiapine group（F =7.454,P =0.026 ; F =9.573,P=0.036）.（3） Body mass inde was （25.73 ±2.77） kg/m^2 and（26.14±3.30） kg/m^2 in risperdone group,while（26.04 ±3.12） kg/m^2 and（26.32 ±3.48） kg/m^2 in quetiapine group at the end of 6th,12th month （F =0.419,P =0.685 ; F =0.216,P =0.823）.（4） In risperidone group,the altering rate of prolactin was negatively correlated with that of bone mineral density （r =-0.62,P =0.023）,while the altering rate of estradiol was positively correlated with that of bone mineral density（r =0.46,P =0.044）.In quetiapine group,the altering rate of prolactin,estradiol and progesterone was not correlated with that of bone mineral density.The altering rate of body mass index was positively correlated with that of bone mineral density in both groups.Conclusion The data indicates that there may be a different effect on prolactin,estradiol,progesterone and lumbar spine bone mineral density,and a similar effect on bone mineral density in the treatment with risperidone and quetiapine.
出处
《中华精神科杂志》
CAS
CSCD
北大核心
2014年第5期288-292,共5页
Chinese Journal of Psychiatry
基金
湖州市科技计划项目（2011YS22）
关键词
精神分裂症
利培酮
奎硫平
生殖激素
骨密度
人体质量指数
Schizophrenia
Risperidone
Quetiapine
Reproductive hormone
Bone density
Body mass index
