| Objective:People have began to pay attention to the impact of antipsychotic drugs for human serum prolactin in the middle of the 1970s,one research showed that more than 60 percent of the patients whose serum prolactin increased in antipsychotic medication, at the same time, different drugs have significant difference. To explore the effects of four kinds of atypical antipsychotic drugs on the levels of serum prolactin and blood lipids, and to analyze their relationship with therapeutic effect in the patients with schizophrenia. The purpose is to provide a certain help for the clinical medication choice.Methods:(1)A total of 200 schizophrenic patients who conformed to the criteria of CCMD-3 for schizophrenia were randomly assigned to risperidone,olanzapine,quetiapine or aripiprazole group for the treatment of twelve weeks.(2) Medicine plan:The drugs began with small doses, and dosages were increased gradually to a therapeutic dose in a week. During the treatment, other antipsychotics were forbidden except the benzodiazepines and anticholinergic drugs when necessary. (3)After gaining informed consent,8ml vein blood was need to be collected from every patient at 7:00 in the morning,next day after they admitted to hospital when his stomach was empty, and to draw blood at the same time point at the end of 12 weeks treatment. Prolactin assay was based on microparticle enzyme-immunoassay technology.(4)The Positive and Negative Symptom Scale(PANSS)needed to be done for all the patients before and at the end of twelve weeks treatment. Levels of serum TC,TG,HDL,LDL and PRL were tested at baseline and the twelve weeks after treatment respectively. In the period of treatment they were undertaken therapeutic effect and treatment emergent symptom scale evaluation. (5)To record various kinds of patients' clinical data in details adopting self-made forms. (6)Use SPSS 10.0 to analysis the data, including chi-square test, ANOVA, paired-test for dependent samples,t-test for independent samples and Spearman correlation analysis. correlation analysis, and other statistical methods.Results:(1)The changes of positive and negative symptom score about the four groups before and after treatment. Before the treatment, the risperidone group'PANSS score was 87.50±14.18, the olanzapine group' was 88.03±13.70, the quetiapine group'was 88.34±15.30, and the aripiprazole group' PANSS score was 88.57±13.65. But at the end of 12 weeks' treatment, the PANSS score of risperidone group was 39.13±10.99, the olanzapine group' PANSS score was 37.10±10.10, the PANSS score of quetiapine group was 42.03±10.60 and the PANSS score of aripiprazole group was 39.13±9.69. The result of statistical analysis was that all of the four groups' PANSS score were decreased significantly after the treatment, the differences had statistic significance(P<0.01).(2)The changes of serum lipid level before and after the treatment of the four groups. After 12 weeks of treatment of risperidone, TC and LDL level obviously higher, and the HDL level lower than before the treatment; after 12 weeks of treatment of olanzapine, TC, TG and LDL level obviously higher, and the HDL level lower than before the treatment; after 12 weeks of treatment of quetiapine, TG level obviously higher, and the HDL level lower than before the treatment; and the result had statistic significance (P<0.01). After 12 weeks of treatment of aripiprazole, LDL level higher, and the result had statistic significance,P<0.05。(3)The changes of serum prolactin'level before and after the treatment of the four groups. Before the treatment, the level of serum prolactin in risperidone group was 13.12±5.99(ng/ml); at the end of 12 weeks treatment, the level in risperidone group was 86.40±8.54(ng/ml).From the statistics, we conclude that the level of serum prolactin in risperidone group improved significantly and the result had statistic significance after statistical analysis(P<0.01). On the other hand,the level of serum prolactin of olanzapine group, quetiapine group and aripiprazole group improved not obviously and had no statistic significance(P>0.05). Risperidone group virus the three groups by analysis of variance, the change of serum prolactin'level had statistic significance(P<0.05). After 12 weeks of treatment of risperidone, the serum prolactin level of female patients obviously higher than male patients, but there is not obvious difference between serum prolactin level female patients and male patients in the other three groups.(4)In aripiprazole group, the change level of serum prolactin was significantly correlated to the change of general psychiatric pathological score(r=0.381, P=0.038); In risperidone group, the change level of serum LDL was significantly correlated to the change of general psychiatric pathological score(r=0.440, P=0.015).In aripiprazole group,the change of serum PRL was significantly correlated to LDL(r=0.559, P=0.001).(5)Compare the adverse reaction of the four group. The rate of adverse reaction was20%,20%,16%,18%,respectively. There were no significant difference in adverse reaction between the four group.Conclusion:(1)All of the four drugs, risperidone, olanzapine, quetiapine and aripiprazole can improve the patients'clinical symptoms after twelve weeks'treatment. The overall effects of the four is similar. (2) All of the four drugs, risperidone, olanzapine, quetiapine and aripiprazole had obviously effects on the metabolism of blood lipid. (3) Risperidone can significantly increase the level of serum prolactin, but the effect of olanzapine, quetiapine and aripiprazole for prolactin is not obviously. (4)The therapeutic effect of aripiprazole was correlated to serum PRL and LDL,and the therapeutic effect of risperidone was correlated to LDL. In aripiprazole group,the change of serum PRL was significantly correlated to LDL. |
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