第二代抗精神病药物奥氮平致代谢失衡的干预措施研究进展
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摘要
奥氮平属于第二代抗精神病药物,已被临床广泛应用,疗效显著。但随着应用时间的推进,临床发现服用奥氮平的患者出现体重增加、糖脂水平异常等代谢失衡的现象较多。药物性代谢失衡不仅是导致心血管疾病发生的危险因素,还会影响到患者的生活质量和用药依从性,导致病程迁延。因此,奥氮平致代谢失衡这一课题备受关注。本文综述了有关该问题的一些国内外干预措施研究进展,以期为临床及机制研究提供参考。
As one of the second-generation antipsychotics, Olanzapine has been widely used in clinic with remarkable curative effect. However, as the application time progressed, it has been found that the incidence of metabolism imbalance is relatively higher in patients taking olanzapine, such as weight gain and abnormal levels of glucose and lipid.Drug-induced metabolism imbalance is a risk factor for cardiovascular disease and could affect the quality of life and patients′ medication compliance resulting in prolonging the course of disease. Olanzapine-induced metabolism imbalance has attracted much attention, and this article reviews the domestic and research progress on interventions of this issue with the hope to provide reference for clinical and mechanism research.
As one of the second-generation antipsychotics, Olanzapine has been widely used in clinic with remarkable curative effect. However, as the application time progressed, it has been found that the incidence of metabolism imbalance is relatively higher in patients taking olanzapine, such as weight gain and abnormal levels of glucose and lipid.Drug-induced metabolism imbalance is a risk factor for cardiovascular disease and could affect the quality of life and patients′ medication compliance resulting in prolonging the course of disease. Olanzapine-induced metabolism imbalance has attracted much attention, and this article reviews the domestic and research progress on interventions of this issue with the hope to provide reference for clinical and mechanism research.
引文
[1]王玉明,刘炳文.奥氮平用于非精神分裂症治疗及不良反应国内研究进展[J].中国实用医药,2017,11(20):279-281.
[2]Komossa K,Rummel-Kluge C,Hunger H,et al.Olanzapine versus other atypical antipsychotics for schizophrenia[J].Cochrane Database Syst Rev,2010,17(3):1-152.
[3]Barak N,Beck Y,Albeck JH.A randomized,double-blind,placebo-controlled pilot study of betahistine to counteract olanzapine-associated weight gain[J].J Clin Psychopharmacol,2016,36(3):253-256.
[4]Saravane D,Feve B,Frances Y,et al.Drawing up guidelines for the attendance of physical health of patients with severe mental illness[J].Encephale,2009,35(4):330-339.
[5]Deng C,Weston-green K,Huang XF.The role of histaminergic H1 and H3 receptors in food intake:a mechanism for atypical antipsychotic-induced weight gain[J].Prog Neuropsychopharmacol Biol Psychiatry,2010,34(1):1-4.
[6]Reynolds GP,Kirk SL.Metabolic side effects of antipsychotic drug treatment pharmacological mechanisms[J].Pharmacol Ther,2010,125(1):169-179.
[7]Müller DJ,Zai CC,Sicard M,et al.Systematic analysis of dopamine receptor genes(DRD1-DRD5)in antipsychoticinduced weight gain[J].Pharmacogenomics J,2012,12(2):156-164.
[8]Melkersson KI,Gunes A,Dahl ML.Impact of serotonin receptor 2A gene halotypes on C-peptide levels in clozapine and olanzapine-treated patients[J].Hum Psychopharmacolo,2010,25(4):347-352.
[9]Malhotra AK,Correll CU,Chowdhury NI,et al.Association between common variants near the melanocortin 4 receptor gene and severe antipsychotic drug-induced weight gain[J].Arch Gen Psychiatry,2012,69(9):904-912.
[10]Newcomer JW.Second-generation(atypical)antipsychotics and metabolic effects:a comprehensive literature review[J].CNS Drugs,2005,19(suppl 1):1-93.
[11]汪莉,隋云川,徐乐平,等.二甲双胍对奥氮平致体重增加精神分裂症患者肝脏脂肪含量的影响[J].中华精神科杂志,2016,49(1):36-41.
[12]董介正,徐莲莲,刘义,等.二甲双胍对奥氮平及喹硫平所致大鼠糖脂代谢紊乱的防治作用[J].中国药理学与毒理学杂志,2014,28(3):362-366.
[13]吴仁容,赵靖平,邵平.二甲双胍对奥氮平所致精神分裂症患者体质量增加的影响[J].中华精神科杂志,2008,41(1):1-4.
[14]Narula PK,Rehan HS,Unni KE,et al.Topiramate for prevention of olanzapine associated weight gain and metabolic dysfunction in schizophrenia:a double-blind,placebo-controlled trial[J].Schizophr Res,2010,118(1-3):218-223.
[15]Shapiro M,Reid A,Olsen B,et al.Topiramate,zonisamide and weight loss in children and adolescents prescribed psychiatric Medications:a medical record review[J].Int J Psychiatry Med,2016,51(1):56-68.
[16]张红梅,张红云,梁炜.托吡酯对奥氮平所致精神分裂症患者体质量增加及血浆瘦素水平的影响[J].临床心身疾病杂志,2016,22(4):1-3.
[17]孙伟,张玖龙,康明秀.合并阿立哌唑改善奥氮平所致女性精神分裂症患者体重增加及催乳素水平升高的研究[J].四川精神卫生,2011,24(2):98-100.
[18]Stroup TS,Mc Evoy JP,Ring KD,et al.A randomized trial examining the effectiveness of switching from Olanzapine,Quetiapine,or Risperidone to Aripiprazole to re duce metabolic risk:comparison of antipsychotics for metabolic problems(CAMP)[J].Am J Psychiatry,2011,168(9):947-956.
[19]李冰,周会爽,张欣,等.合用阿立哌唑可减轻奥氮平治疗所致精神分裂症患者血脂水平升高[J].中国神经精神疾病杂志,2012,38(9):551-553.
[20]汪卫华,刘丽,李光耀,等.阿立哌唑治疗奥氮平所致精神分裂症患者体质量增加的随机双盲对照研究[J].临床精神医学杂志,2016,26(2):89-91.
[21]López-Mato A,Rovner J,Illa G,et al.Randomized,open label study on the use of ranitidine at different doses for the management of weight gain associated with olanzapine administration[J].Vertex,2003,14(52):85-96.
[22]Atmaca M,Kuloglu M,Tezcan E,et al.Nizatidine for the treatment of patients with quetiapine-induced weight gain[J].Hum Psychophamacol,2004,19(1):37-40.
[23]Cavazzoni P,Tanaka Y,Roychowdhury SM,et al.Nizatidine for prevention of weight gain with olanzapine:a doub Ie-blind placebo-controlled tria1[J].Eur Neuropsychopharmacol,2003,13(2):81-85.
[24]Ranjbar F,Ghanepour A,Sadeghi-Bazargani H,et al.The effect of ranitidine on olanzapine-induced weight gain[J].Biomed Res Int,2013,20(11):639-643.
[25]梁美娟.雷尼替丁对服用奥氮平治疗精神分裂症患者糖脂代谢水平及体重的影响[J].中国医院用药评价与分析,2016,16(4):433-436.
[26]李祎鋆,王昭,梁美娟,等.雷尼替丁预防精神分裂症患者服药奥氮平引起体质量增加及糖脂代谢障碍的研究[J].河南医学研究,2016,25(12):2121-2124.
[27]洪二郎,廖湘交,常凤坤.脑心清片对奥氮平治疗的精神分裂症患者糖脂代谢的影响[J].现代中西医结合杂志,2017,26(15):1686-1687
[28]杨忠,周联军,尹建兵,等.复方丹参滴丸治疗精神分裂症患者代谢综合征的疗效分析[J].中西医结合心脑血管病杂志,2011,9(8):964-965.
[29]谢穗峰,喻俊,钟远惠,等.复方丹参滴丸治疗慢性精神分裂症并脂代谢异常患者的效果分析[J].河南医学研究,2016,25(6):1030-1031.
[30]谢穗峰,钟远惠,喻俊,等.探讨复方丹参滴丸治疗奥氮平所致代谢综合征的疗效及安全性[J].中国实用神经疾病杂志,2017,20(9):1-4.
[31]杨英俏,姚祖培.代谢综合征与炎症反应和血淤证的关系[J].中西医结合心脑血管病杂志,2013,11(1):3681-3682.
[32]李学军,周艺,闫冰,等.代谢综合征患者之血淤证研究[J].中医研究,2008,8(21):19-22.
[33]伍新林,王明军,邝昱,等.脑心清片对血脂及血黏状态的临床研究[J].中药材,2008,31(1):171-174.
[34]Zhang JP,Lencz T,Zhang RX,et al.Pharmacogenetic associations of antipsychotic drug-related weight gain:a systematic review and Meta-analysis[J].Schizophr Bull,2016,42(6):1418-1437.
[35]吴卫英,费玉娥.护理干预对奥氮平致代谢综合征患者的影响[J].中国实用护理杂志,2013,29(15):33-35.
[36]樊爱珍,王怀海,张瑞国.护理干预对奥氮平致肥胖患者体重的影响[J].护理学杂志,2005,20(11):42-43.
[37]汤娟萍,苏雅芳.38例服用奥氮平致体质量增加患者的护理[J].护理学报,2010,12(7A):64-65.
[38]许慧琴,高国豪,龚民.精神病医院开展精神病药物药学服务初探[J].中国实用医药,2008,3(31):195-196.
[39]宋娥美,谢苗星,刘达平,等.药师临床干预对双相情感障碍患者治疗依从性及生活质量的影响[J].临床心身疾病杂志,2016,22(3):91-94.
[2]Komossa K,Rummel-Kluge C,Hunger H,et al.Olanzapine versus other atypical antipsychotics for schizophrenia[J].Cochrane Database Syst Rev,2010,17(3):1-152.
[3]Barak N,Beck Y,Albeck JH.A randomized,double-blind,placebo-controlled pilot study of betahistine to counteract olanzapine-associated weight gain[J].J Clin Psychopharmacol,2016,36(3):253-256.
[4]Saravane D,Feve B,Frances Y,et al.Drawing up guidelines for the attendance of physical health of patients with severe mental illness[J].Encephale,2009,35(4):330-339.
[5]Deng C,Weston-green K,Huang XF.The role of histaminergic H1 and H3 receptors in food intake:a mechanism for atypical antipsychotic-induced weight gain[J].Prog Neuropsychopharmacol Biol Psychiatry,2010,34(1):1-4.
[6]Reynolds GP,Kirk SL.Metabolic side effects of antipsychotic drug treatment pharmacological mechanisms[J].Pharmacol Ther,2010,125(1):169-179.
[7]Müller DJ,Zai CC,Sicard M,et al.Systematic analysis of dopamine receptor genes(DRD1-DRD5)in antipsychoticinduced weight gain[J].Pharmacogenomics J,2012,12(2):156-164.
[8]Melkersson KI,Gunes A,Dahl ML.Impact of serotonin receptor 2A gene halotypes on C-peptide levels in clozapine and olanzapine-treated patients[J].Hum Psychopharmacolo,2010,25(4):347-352.
[9]Malhotra AK,Correll CU,Chowdhury NI,et al.Association between common variants near the melanocortin 4 receptor gene and severe antipsychotic drug-induced weight gain[J].Arch Gen Psychiatry,2012,69(9):904-912.
[10]Newcomer JW.Second-generation(atypical)antipsychotics and metabolic effects:a comprehensive literature review[J].CNS Drugs,2005,19(suppl 1):1-93.
[11]汪莉,隋云川,徐乐平,等.二甲双胍对奥氮平致体重增加精神分裂症患者肝脏脂肪含量的影响[J].中华精神科杂志,2016,49(1):36-41.
[12]董介正,徐莲莲,刘义,等.二甲双胍对奥氮平及喹硫平所致大鼠糖脂代谢紊乱的防治作用[J].中国药理学与毒理学杂志,2014,28(3):362-366.
[13]吴仁容,赵靖平,邵平.二甲双胍对奥氮平所致精神分裂症患者体质量增加的影响[J].中华精神科杂志,2008,41(1):1-4.
[14]Narula PK,Rehan HS,Unni KE,et al.Topiramate for prevention of olanzapine associated weight gain and metabolic dysfunction in schizophrenia:a double-blind,placebo-controlled trial[J].Schizophr Res,2010,118(1-3):218-223.
[15]Shapiro M,Reid A,Olsen B,et al.Topiramate,zonisamide and weight loss in children and adolescents prescribed psychiatric Medications:a medical record review[J].Int J Psychiatry Med,2016,51(1):56-68.
[16]张红梅,张红云,梁炜.托吡酯对奥氮平所致精神分裂症患者体质量增加及血浆瘦素水平的影响[J].临床心身疾病杂志,2016,22(4):1-3.
[17]孙伟,张玖龙,康明秀.合并阿立哌唑改善奥氮平所致女性精神分裂症患者体重增加及催乳素水平升高的研究[J].四川精神卫生,2011,24(2):98-100.
[18]Stroup TS,Mc Evoy JP,Ring KD,et al.A randomized trial examining the effectiveness of switching from Olanzapine,Quetiapine,or Risperidone to Aripiprazole to re duce metabolic risk:comparison of antipsychotics for metabolic problems(CAMP)[J].Am J Psychiatry,2011,168(9):947-956.
[19]李冰,周会爽,张欣,等.合用阿立哌唑可减轻奥氮平治疗所致精神分裂症患者血脂水平升高[J].中国神经精神疾病杂志,2012,38(9):551-553.
[20]汪卫华,刘丽,李光耀,等.阿立哌唑治疗奥氮平所致精神分裂症患者体质量增加的随机双盲对照研究[J].临床精神医学杂志,2016,26(2):89-91.
[21]López-Mato A,Rovner J,Illa G,et al.Randomized,open label study on the use of ranitidine at different doses for the management of weight gain associated with olanzapine administration[J].Vertex,2003,14(52):85-96.
[22]Atmaca M,Kuloglu M,Tezcan E,et al.Nizatidine for the treatment of patients with quetiapine-induced weight gain[J].Hum Psychophamacol,2004,19(1):37-40.
[23]Cavazzoni P,Tanaka Y,Roychowdhury SM,et al.Nizatidine for prevention of weight gain with olanzapine:a doub Ie-blind placebo-controlled tria1[J].Eur Neuropsychopharmacol,2003,13(2):81-85.
[24]Ranjbar F,Ghanepour A,Sadeghi-Bazargani H,et al.The effect of ranitidine on olanzapine-induced weight gain[J].Biomed Res Int,2013,20(11):639-643.
[25]梁美娟.雷尼替丁对服用奥氮平治疗精神分裂症患者糖脂代谢水平及体重的影响[J].中国医院用药评价与分析,2016,16(4):433-436.
[26]李祎鋆,王昭,梁美娟,等.雷尼替丁预防精神分裂症患者服药奥氮平引起体质量增加及糖脂代谢障碍的研究[J].河南医学研究,2016,25(12):2121-2124.
[27]洪二郎,廖湘交,常凤坤.脑心清片对奥氮平治疗的精神分裂症患者糖脂代谢的影响[J].现代中西医结合杂志,2017,26(15):1686-1687
[28]杨忠,周联军,尹建兵,等.复方丹参滴丸治疗精神分裂症患者代谢综合征的疗效分析[J].中西医结合心脑血管病杂志,2011,9(8):964-965.
[29]谢穗峰,喻俊,钟远惠,等.复方丹参滴丸治疗慢性精神分裂症并脂代谢异常患者的效果分析[J].河南医学研究,2016,25(6):1030-1031.
[30]谢穗峰,钟远惠,喻俊,等.探讨复方丹参滴丸治疗奥氮平所致代谢综合征的疗效及安全性[J].中国实用神经疾病杂志,2017,20(9):1-4.
[31]杨英俏,姚祖培.代谢综合征与炎症反应和血淤证的关系[J].中西医结合心脑血管病杂志,2013,11(1):3681-3682.
[32]李学军,周艺,闫冰,等.代谢综合征患者之血淤证研究[J].中医研究,2008,8(21):19-22.
[33]伍新林,王明军,邝昱,等.脑心清片对血脂及血黏状态的临床研究[J].中药材,2008,31(1):171-174.
[34]Zhang JP,Lencz T,Zhang RX,et al.Pharmacogenetic associations of antipsychotic drug-related weight gain:a systematic review and Meta-analysis[J].Schizophr Bull,2016,42(6):1418-1437.
[35]吴卫英,费玉娥.护理干预对奥氮平致代谢综合征患者的影响[J].中国实用护理杂志,2013,29(15):33-35.
[36]樊爱珍,王怀海,张瑞国.护理干预对奥氮平致肥胖患者体重的影响[J].护理学杂志,2005,20(11):42-43.
[37]汤娟萍,苏雅芳.38例服用奥氮平致体质量增加患者的护理[J].护理学报,2010,12(7A):64-65.
[38]许慧琴,高国豪,龚民.精神病医院开展精神病药物药学服务初探[J].中国实用医药,2008,3(31):195-196.
[39]宋娥美,谢苗星,刘达平,等.药师临床干预对双相情感障碍患者治疗依从性及生活质量的影响[J].临床心身疾病杂志,2016,22(3):91-94.