二甲双胍治疗奥氮平致精神分裂症患者代谢综合征的疗效观察*

Efficacy of metformin in metabolic syndrome induced by olanzapine in schizophrenia patients*

摘要:

目的 探讨二甲双胍治疗奥氮平致精神分裂症患者代谢综合征（MS）过程中炎症因子的变化及对 体重指数（BMI）和糖脂代谢的影响。方法 选取2017年1月—2020年1月温州医科大学附属康宁医院收治的精 神分裂症患者100例，按照随机数字表法分为观察组与对照组，每组50例。两组患者维持原有奥氮平治疗方案， 且合理增加运动量、督促饮食控制，进行生活方式干预及健康教育。观察组在此基础上口服盐酸二甲双胍片。两 组治疗时间均为24周。比较两组治疗前与治疗24周BMI和稳态胰岛素评价指数（HOMA-IR）、血糖、血脂和炎 症因子的变化。结果 观察组治疗前后BMI和HOMA-IR的差值高于对照组（P <0.05）。观察组治疗前后空腹 血浆葡萄糖和糖化血红蛋白的差值高于对照组（P <0.05）。观察组治疗前后高密度脂蛋白胆固醇、低密度脂蛋白 胆固醇、总胆固醇和甘油三酯的差值高于对照组（P <0.05）。观察组治疗前后C反应蛋白和肿瘤坏死因子-α的差 值高于对照组（P <0.05）。结论 二甲双胍治疗奥氮平致精神分裂症患者MS效果良好，可降低BMI，改善血脂 代谢紊乱，减轻炎症反应。

Abstract:

Objective To investigate the changes of inflammatory factors and their effects on body mass index (BMI) and glucose and lipid metabolism in schizophrenia patients with metabolic syndrome induced by olanzapine. Methods The 100 schizophrenia patients admitted to our hospital from January 2017 to January 2020 were enrolled and divided into observation group (n = 50) and control group (n = 50). During the study period, the original olanzapine treatment was maintained. The two groups of patients received lifestyle intervention, on the basis of health education, diet control, and proper exercise, while the observation group was additionally given metformin hydrochloride tablets orally. The course of treatment was 24 weeks in both groups. The changes of BMI, Homeostatic Model Assessment of Insulin Resistance (HOMA-IR), blood glucose, blood lipid and inflammatory factors were compared between the two groups before and after 24 weeks of treatment. Results The differences of BMI, HOMA-IR, fasting plasma glucose (FPG), and glycosylated hemoglobin (HbA1c) before and after treatment in the observation group were higher than those in the control group (P < 0.05). The differences of high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), total cholesterol (TC) and triglyceride (TG) in the observation group before and after treatment were higher than those in the control group as well (P < 0.05). In addition, the differences of C-reactive protein (CRP) and tumor necrosis factor-α (TNF-α) before and after treatment in the observation group were higher than those in the control group (P < 0.05). Conclusions Metformin has a good effect in the treatment of metabolic syndrome induced by olanzapine in schizophrenia patients, playing roles in reducing BMI, improving dyslipidemia and ameliorating inflammatory reaction.