The Research On Glucose And Lipid Metabolic Dysfunction Of Schizophrenia Patients And Metabolic Adverse Effect Of Antipsychotic Drugs

Objective:(1)To study whether first-episode, drug-naive schizophrenia patients in Chinese had glucose and lipid metabolic abnormality or not.(2)To study the potential effects of antipsychotic medications on glucose and lipid metabolism in Chinese patients with schizophrenia.(3)To study the possible variation of glucose and lipid metabolism in Chinese patients with schizophrenia after discontinuation of antipsychotic medications.Methods:(1)DSM-IV diagnosis of schizophrenia was established for131inpatients by using SCID. Among of them,70patients were drug-naive, first-episode schizophrenia(drug-nai’ve group),33patients were were schizophrenia with continuous antipsychotic drugs use≥1year on admission(drug treatment group), and28patients were schizophrenia with ever continuous antipsychotic drugs use≥1year and now antipsychotic drugs withdrawal≥3months(drug withdrawal group).44healthy volunteers whose age, gender, nationality and education matched with patients were recruited through advertising and evaluated by using the SCID-Nonpatietn edition (SCID-NP)(healthy group).(2)Blood samples (10ml) of all study subjects were collected after a10h overnight fast and tested for measurements of fasting serum levels of glucose, insulin, C-peptide, and lipid profiles including total cholesterol (TC), triglyseride (TG), high density lipoprotein cholesterol (HDL-C), apolipoproteinAl (aPOA1) and apolipoproteinB100(aPOB100). The formulae for the homeostasis assessment model are as follows: HOMA-IR=[FPG (mmol/1)xFINS (103uU/L)]/22.5. Anthropometric measurements (weight, height, waist and hip circumference) were collected at the same time with blood sample collection, and body mass index (BMI) and waist-hip ratio (WHR) were figured out.(3)For all objects of study, PANSS was performed by an experienced clinical psychiatrist to assess the severity of symptom on admission.Results:(1)No statistical difference from BMI, WHR and waistline between drug-naive, first-episode schizophrenia patients and healthy controls were found(p>0.05). No significant difference of FPG between the two groups was found (P=0.909). Drug-naive, first-episode schizophrenia patients had a higher fasting serum levels of insulin, C-peptide, and had a lower fasting plasma levels of TC, HDL-C and apolipoproteinAl, and were more insulin resistant (P<=0.01), compared to healthy subjects.(2)Compared to drug-naive, first-episode schizophrenia patients, those patients with continuous antipsychotic drugs use≥1year had shown a significant augmentation of BMI, WHR and waistline (P<0.01), and significant rise of FINS and its resistance, C-peptide levels (P<0.01), accompanied by a significant rise of serum concentration of TG (P<0.01) and LP(a) levels (P<0.05) and a remarkable reducing of HDL-c levels (P<0.05).(3)Compared to schizophrenia patients with continuous antipsychotic drugs use≥1year, those patients with antipsychotic drugs withdrawal>3months had not shown a remarkable improvement trend from BMI, WHR, waistline, glucose and other lipid metabolism abnormality (P>0.05) However, the improvement of TG had arrived at significant difference (P=0.040)(4)Compared to drug-naive, first-episode schizophrenia patients, drug withdrawal schizophrenia patients still had a significantly higher BMI, waistline, FINS, C-peptide and HOMA-IR levels (P<0.05), and still had a significantly lower HDL-c levels (P<0.05)Conclusion:(1)The glucose and lipid metabolism abnormality of schizophrenia patients may be occurred prior to any antipsychotic drugs treatment, these possibly included the significant increased levels of FINS, C-peptide, HOMA-IR, and the prominent reducing of TC, HDL-c and apolipoproteinA1levels. (2)Antipsychotic drugs treatment possibly exacerbated glucose and lipid dysregulation in Chinese patients with schizophrenia, these included the remarkable augmentation of BMI, WHR and waistline, the significant rise of insulin, C-peptide and HOMA-IR levels, the significant rise of TG and LP(a) levels, and the prominent reducing of HDL-c levels.(3)Although the average0.67(SD=0.55) years discontinuation of antipsychotic drugs may significantly improve the state of TG dysregulation in Chinese patients with schizophrenia, it may not be in fovour of remission of glucose and other lipid dysregulation.