二甲双胍治疗抗精神病药物引起的血脂异常：两项随机、安慰剂的对照研究

杨叶; 王肖依; 康冬禹; 龙雨君; 欧建君; 郭文斌; 赵靖平; 吴仁容

doi:10.11817/j.issn.1672-7347.2019.180379

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论著 | 更新时间：2020-06-14

二甲双胍治疗抗精神病药物引起的血脂异常：两项随机、安慰剂的对照研究
Metformin treatment of antipsychotic-induced dyslipidemia: analysis of two randomized, placebo-controlled trials
中南大学学报（医学版） 中南大学学报（医学版） 2019年44卷第10期页码：1128-1136
作者机构：

中南大学湘雅二医院精神卫生研究所，长沙 410011
作者简介：

杨叶，Email: 2411960431@qq.com, ORCID: 0000-0003-1224-5315
吴仁容，Email: wurenrong@csu.edu.cn, ORCID: 0000-0003-1758-4738
基金信息：

国家自然科学基金(81371481);国家科技重大专项(2012ZZX09303014-001);National Natural Science Foundation(81371481);National Science and Technology Major Projects(2012ZZX09303014-001)
DOI：10.11817/j.issn.1672-7347.2019.180379
中图分类号：
CSTR：
纸质出版日期： 2019-10-01 ，

收稿日期： 2018-06-27 ，

杨叶, 王肖依, 康冬禹, 龙雨君, 欧建君, 郭文斌, 赵靖平, 吴仁容. 二甲双胍治疗抗精神病药物引起的血脂异常：两项随机、安慰剂的对照研究[J]. 中南大学学报(医学版), 2019, 44(10): 1128-1136.

YANG Ye, WANG Xiaoyi, KANG Dongyu, LONG Yujun, OU Jianjun, GUO Wenbin, ZHAO Jingping, WU Renrong. Metformin treatment of antipsychotic-induced dyslipidemia: analysis of two randomized, placebo-controlled trials[J]. Journal of Central South University. Medical Science, 2019, 44(10): 1128-1136.
杨叶, 王肖依, 康冬禹, 龙雨君, 欧建君, 郭文斌, 赵靖平, 吴仁容. 二甲双胍治疗抗精神病药物引起的血脂异常：两项随机、安慰剂的对照研究[J]. 中南大学学报(医学版), 2019, 44(10): 1128-1136. DOI：10.11817/j.issn.1672-7347.2019.180379

YANG Ye, WANG Xiaoyi, KANG Dongyu, LONG Yujun, OU Jianjun, GUO Wenbin, ZHAO Jingping, WU Renrong. Metformin treatment of antipsychotic-induced dyslipidemia: analysis of two randomized, placebo-controlled trials[J]. Journal of Central South University. Medical Science, 2019, 44(10): 1128-1136. DOI：10.11817/j.issn.1672-7347.2019.180379

摘要

目的：

验证二甲双胍治疗抗精神病药引起的血脂异常的疗效和安全性。

方法：

将两项随机、安慰剂的对照研究纳入分析。共有201例服用抗精神病药物后出现血脂异常的首发精神分裂症患者，并将其分为1 000 mg/d二甲双胍组(以下简称为二甲双胍组，

=103)和安慰剂组(

=98)，观察24周。在基线、治疗后第12周和第24周进行临床症状及体重、血糖、血脂等代谢指标的评估。

结果：

二甲双胍治疗后，二甲双胍组和安慰剂组之间低密度脂蛋白胆固醇(low density lipoprotein cholesterol，LDL-C)的平均差异从基线时的0.16 mmol/L，降低到第24周结束时的–0.86 mmol/L，降低了1.02 mmol/L，差异有统计学意义(

0.01)。而24周结束时，二甲双胍组LDL-C≥3.37 mmol/L的患者有25.3%，显著低于安慰剂组24周结束时的64.8%(

0.01)。与安慰剂组相比，二甲双胍组的体重、体重指数、胰岛素、胰岛素抵抗指数、总胆固醇、三酰甘油和高密度脂蛋白胆固醇也有显著变化，差异均有统计学意义(均

0.05)。治疗对体重和胰岛素抵抗的影响出现在第12周，并且在第24周进一步改善，但对改善血脂异常的作用在第24周结束时才出现。

结论：

二甲双胍治疗对于改善抗精神病药物引起的血脂异常和胰岛素抵抗是有效的，并且改善抗精神病药物诱导的胰岛素抵抗出现的时间早于降低血脂异常的时间。

Abstract

Objective:

To examine the efficacy and safety for metformin in treating antipsychotic-induced dyslipidemia.

Methods:

Two randomized placebo-controlled trials were included in the analysis. A total of 201 schizophrenia patients with dyslipidemia after treatment with an antipsychotic were collected

and the patients were divided into two groups: a 1 000 mg/d metformin group (

=103) and a placebo group (

=98). The clinical symptoms and metabolic indicators such as body weight

blood glucose

and blood lipids were assessed at baseline

the 12th week and the 24th week after treatment respectively.

Results:

After metformin treatment

the mean difference in the low-density lipoprotein cholesterol (LDL-C) value between the metformin group and the placebo group was from 0.16 mmol/L at baseline to –0.86 mmol/L at the end of the 24th week

which was decreased by 1.02 mmol/L (

0.01). At the 24th week

the LDL-C was more than 3.37 mmol/L in 25.3% patients in the metformin group

which was significantly lower than that in the placebo group (64.8%) (

0.01). Compared with the placebo group

there were significant changes in the weight

body mass index (BMI)

insulin

insulin resistance index

total cholesterol and triglyceride

and high-density lipoprotein cholesterol (HDL-C) in the metformin group (all

0.05). The treatment effects on weight and insulin resistance appeared at the 12th week and further improved at the 24th week

but the effects on improving dyslipidemia only significantly occurred at the end of the 24th week.

Conclusion:

The metformin treatment is effective in improving antipsychotic-induced dyslipidemia and insulin resistance

and the effect to reduce the antipsychotic-induced insulin resistance appears earlier than the effect to improve dyslipidemia.

关键词

精神分裂症二甲双胍血脂异常

Keywords

schizophreniametformindyslipidemia

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