摘要目的 观察奥氮平对首次发病精神分裂症患者肝脏脂肪含量(liver fat content,LFC)的影响.方法 首次发病精神分裂症25例患者(患者组)接受奥氮平单药治疗,剂量为10～ 20 mg/d,疗程8周.患者组分别于治疗前、治疗后(第8周末),采用质子磁共振波谱分析测定LFC,并与25名健康人(对照组)进行比较;患者组另予测定人体学指标[体质量指数(body mass index,BMI)、腰围/身高比(waist-height ratio,WHR)]、血清代谢指标(空腹血糖、甘油三酯、胆固醇)及稳态模型评估的胰岛素抵抗指数(homeostasis model assessment of insulin resistance,HOMA-IR).结果 (1)治疗后患者组LFC较治疗前增高(分别为4.99％±1.79％、3.98％±0.83％,=2.958,P ＜0.01),并高于对照组(4.02％±0.80％,t=2.436,P＜0.05),差异有统计学意义;(2)治疗后患者组BMI、WHR、甘油三酯、胆固醇、HOMA-IR较治疗前增高;(3)治疗前患者组LFC值与HOMA-IR、BMI、WHR、甘油三酯呈正相关(r=0.447、0.424、0.421、0.413,均P＜0.05);治疗后LFC值与HOMA-IR、甘油三酯呈正相关(r=0.425、0.400,均P＜0.05);治疗前后LFC变化值与HOMA-IR、WHR变化值呈正相关(r=0.478,P＜0.01;r =0.430,P ＜0.05);(4)治疗后患者组有4例(4/25,16％)LFC高于脂肪肝诊断临界值(LFC＞5.5％).结论 奥氮平治疗可能增加精神分裂症患者肝脏的脂肪沉积.

abstractsObjective To observe the effects of olanzapine treatment upon liver tat content (LFC)in first-episode schizophrenia patients.Methods A total of 25 first-episode schizophrenia patients were administered olanzapine alone with dosage ranging from 10 to 20 mg per day for eight weeks.1H-magnetic resonance spectroscopy (1H-MRS) was used for LFC measurements before and after eight-week olanzapine treatment.The results were compared with those of the normal control group (n =25).Other indicators,including body mass index (BMI),waist-height ratio (WHR),fasting plasma glucose (FPG),triglyceride (TG),total cholesterol (TC) and homeostasis model assessment of insulin resistance (HOMA-IR),were also assessed in the patients group.Results After olanzapine treatment,the LFC significantly increased against the pre-treatment level ((4.99 ± 1.79) ％ vs.(3.98 ± 0.83) ％,t =2.958,P ＜ 0.01),and against that of the normal control group ((4.99 ± 1.79)％ vs.(4.02 ± 0.80)％,t =2.436,P＜0.05).The levels of BMI,WHR,TG,TC and HOMA-IR were all significantly elevated after treatment.Before treatment,LFC was positively correlated to HOMA-IR,BMI,WHR and TG (r =0.447,0.424,0.421,0.413 ; all P ＜ 0.05),while after treatment,LFC was positively correlated to HOMA-IR and TG(r =0.425,0.400; both P ＜0.05) ; the increase of LFC between pre-and post-treatment was positively correlated to the increases of HOMA-IR and WHR (r =0.478,P ＜ 0.01 ; r =0.430,P ＜ 0.05).After treatment,the LFC of 4 patients (16％) surpassed the threshold diagnostic value of fatty liver (LFC ＞ 5.5％).Conclusion Olanzapine treatment would significantly elevate liver fat deposition in first-episode schizophrenia patients.