CAJ | 학술논문

目的探讨精神分裂症患者接受利培酮治疗中出现的类帕金森征(TEP)与中枢5-羟色胺(5-HT)功能的关系.方法 102例首发精神分裂症患者,接受固定剂量(4mg/d)利培酮治疗后,逐日评定Simpson-Angus量表,对TEP发生进行6周的随访.分别于利培酮治疗前、治疗后(随访第3天)行帕罗西汀激发试验,以催乳素(PRL)、皮质醇(COR)的基础值、峰值(基础值校正后)和曲线下面积(AUC)值为应答指标.结果随访期TEP发生率为70.6%,发生时间为随访第3～38天.治疗后,激发试验各时点PRL/COR连线的曲线轮廓,与治疗前不平行(均P<0.01);PRL应答的基础值升高、峰值及AUC值降低(均P<0.01);COR应答的基础值、峰值、AUC值降低(均P<0.01).利培酮对出现/不出现TEP者PRL基础值、COR AUC值的影响存在差异(P<0.05);出现TEP者,治疗后PRL基础值[104.9±38.8)μg/L VS(87.4±33.1)μg/L,P<0.05]、COR峰值[(46.2±17.9)μg/L,(34.3±17.3)μg/L,P<0.01]及AUC值高于不出现者;2组治疗后COR应答指标的总体均数向量存在差异(P=0.000).Cox比例风险模型分析显示,治疗后COR AUC低值组不易发生TEP(RR=0.484,95%CI=0.301～0.781).结论 5-HT系统可能参与了TEP形成机制,利培酮对5-HT的拮抗有助于减少TEP的发生.
목적 탐토정신분렬증환자접수리배동치료중출현적류파금삼정(TEP)여중추5-간색알(5-HT)공능적관계.방법 102례수발정신분렬증환자,접수고정제량(4mg/d)리배동치료후,축일평정Simpson-Angus량표,대TEP발생진행6주적수방.분별우리배동치료전、치료후(수방제3천)행파라서정격발시험,이최유소(PRL)、피질순(COR)적기출치、봉치(기출치교정후)화곡선하면적(AUC)치위응답지표.결과 수방기TEP발생솔위70.6%,발생시간위수방제3～38천.치료후,격발시험각시점PRL/COR련선적곡선륜곽,여치료전불평행(균P<0.01);PRL응답적기출치승고、봉치급AUC치강저(균P<0.01);COR응답적기출치、봉치、AUC치강저(균P<0.01).리배동대출현/불출현TEP자PRL기출치、COR AUC치적영향존재차이(P<0.05);출현TEP자,치료후PRL기출치[104.9±38.8)μg/L VS(87.4±33.1)μg/L,P<0.05]、COR봉치[(46.2±17.9)μg/L,(34.3±17.3)μg/L,P<0.01]급AUC치고우불출현자;2조치료후COR응답지표적총체균수향량존재차이(P=0.000).Cox비례풍험모형분석현시,치료후COR AUC저치조불역발생TEP(RR=0.484,95%CI=0.301～0.781).결론 5-HT계통가능삼여료TEP형성궤제,리배동대5-HT적길항유조우감소TEP적발생.
Objective To study the associations between risperidone-treatment-emergement parkinsonism (TEP) and central serotonergic function.Methods TEP was assessed by Simpson-Angus scale daily for a 6-week follow-up study in 102 first-episode schizophrenics taking a fixed dose of risperidone 4 rag/day.Paroxetine neuroendocrine challenge test was conducted before treatment and 3rd day after treatment of risperidone 4 mg/day.The baseline level,the peak level and the area under the curve (AUC) corrected by the baseline level were showed as characteristic parameters of prolactin (PRL)/ eorticosterone (COR)response to challenge.Results Comparing with pre-treatment,there was a significant decrease in PRL/COR response to paroxetine ehalhnge after treatment.Cases with TEP had a significantly higher baseline PRL[104.9±38.8)μg/L vs (87.4±33.1)μg/L,P=0.033] ,corrected peak COR[(46.2±17.9)μg/L vs (34.3±17.3)μg/L,P=0.003] and AUC COR than those without TEP,while a significant greup-by-treatment interaction for baseline PRL and AUC COR response was showed(P=0.031,0.034).The mean vector of characteristic parameters of COR response to paroxetine was significantly different between two groups(P=0.000) ;and lower AUC COR response after treatment was showed as an independent protective factor of TEP based on Cox model analysis(RR=0.484,95% CI=0.301～0.781).Conclusions This study supports that the serotonergic system may play a role in the mechanism of TEP.The resuits also suggest that the serotonin antagonistic activity of risperidone contributes to decreasing the risk of TEP.