抗精神病药与代谢综合征

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1、抗精神病物与代谢综合症预防与干预的思考中南大学湘雅二医院精神卫生研究所赵靖平代谢综合症:概念包含下述心血管疾病(CVD)危险因素的群体:向心性肥胖(腰围),体质量血脂异常甘油三酯高密度脂蛋白（HDL-C）血压空腹血糖(FPG)代谢综合症的标准ATPIII(2000)ATPIIIU(2004)1IDF(2005)1腰围M≥40英寸,F≥35英寸M≥40英寸F≥35英寸白种人M≥35英寸,F≥31英寸美国亚裔南亚/中国人Tg150mg/dL150mg/dL或正在接受药物治疗HDL-CM<40mg/dL/F<50mg/dLM<40mg/dL/F<50mg/dL或正在接

2、受药物治疗BP130/85mmHg130/85mmHg或正在接受药物治疗FPG110mg/dL100mg/dL或正在接受药物治疗1identifythesameMetSindividualsandneedidenticalclinicalmanagement1GrundySM,etal.Circulation2005,112:2735-52.其他处理对策行为干预：限制进食，增加锻炼，防治肥胖药物干预(5-HT2和H1-R阻断剂)厌食药物芬氟拉明：心脏毒性,加重病情新型抗抑郁药抗糖尿病药物，如二甲双胍（精神科与全科联合治疗）Metforminadditiontoattenu

3、ateolanzapine-inducedweightgainindrug-naivefirst-episodeschizophreniapatients:adouble-blind,placebo-controlledstudyIntroductionMetforminisahepatic-selectiveinsulinsensitizerMetformincanincreasetissuesensitivitytoinsulinandreduceinhepaticglucoseoutputMetforminreducesweight,bloodglucose,insulinand

4、hemoglobinAlc(HbAlc)levelsinobesenondiabeticadultsMetforminisnotmetabolizedanddoesnotinhibitthemetabolismofotherdrugsAlitterstudyprovedefficacyThepurposewastoassesstheefficacyofmetformininpreventingolanzapine-inducedweightgainMethod首发住院患者,可以单一使用olanzapine治疗18-50岁40patientswererandomizedto:olanzap

5、ine[15mg/day]plusmetformin[750mg/day,250mg/tid][n=20]orolanapine[15mg/day]plusplacebo[n=20]Medicationswereprovidedindouble-blindfashionMethodsAssessmentsincluded:bodyweight,bodymassindex(BMI),waist-hip-ratio(WHR)fastingglucose,insulinandIRIevaluatedat8and12wkstheproportionofpatientshadgained>7%of

6、theirbodyweightat12weeksResults(1)Demographicandbasicdescriptivedata37(92.7%)patientsfinished12wksassessmentNodifferencein:Age,sex,DurationofdiseaseWeight(kg),BMI(18.5-23.9kg/m2),Waistcircumference(cm)FG(3.5-6.4mmol/l),Insulin(4-16.8μIU/ml),WHR(men<0.91,women<0.81),IRI(<4)Results(2)Between-group

7、differencesinbodyweightgainolanzapineplusmetformin:1.90±2.72kgolanzapineplusplacebo:6.87±4.23kgt=-2.86,df=35,P<0.01(第8,12周的体质量两组存在显著性差异)Results(3)Between-groupdifferencesinBMImeanchangeolanzapineplusmetformingroup:0.5