利培酮单药或联合用药治疗后甲状腺激素水平的变化

目的：探讨利培酮单药或与其他第二代抗精神病药物联合用药治疗后，精神病人体内甲状腺激素水平的变化。方法：回顾29例接受利培酮单药治疗，25例接受联合用药治疗的住院患者病例，分析治疗前后血清甲状腺激素水平的变化。结果：利培酮单药治疗后，游离四碘甲状腺原氨酸（FT4）、总四碘甲状腺原氨酸（TT4）血清水平降低，促甲状腺激素（TSH）血清水平升高，与治疗前相比，差异有统计学意义（相对于基线变化值的中位数：FT4：－2.52 pmol/L，P<0.001；TT4：－21.17 nmol/L，P=0.012；TSH：0.49 mIU/L，P=0.001）。利培酮与其他第二代抗精神病药物联合用药治疗后，游离三碘甲状腺原氨酸（FT3）、总三碘甲状腺原氨酸（TT3）及FT4血清水平降低，TSH血清水平升高，与治疗前相比，差异有统计学意义（相对基线变化值的中位数：FT3：－0.37 pmol/L，P=0.001；TT3：－0.17 nmol/L，P=0.008；FT4：－2.25 pmol/L，P<0.001；TSH：0.97 mIU/L，P=0.029）。单药组中血清TT4水平的变化值与利培酮平均日剂量呈中度正相关（P=0.037, r=0.390）。治疗后，单药组和联合用药组中亚临床甲状腺功能异常发生率分别为6.9%和12.0%，组间差异无统计学意义（P=0.862）。结论：在用利培酮治疗精神分裂症时，应关注患者血清甲状腺激素水平的变化，避免甲状腺激素水平异常引起其他的疾病。

Changes in serum thyroid hormone levels in psychiatric patients after risperidone monotherapy or polytherapy treatment

AIM: To investigate changes in serum thyroid hormone levels in psychiatric patients after risperidone monotherapy or polytherapy treatment. METHODS: Twenty-nine in-patients who received risperidone monotherapy treatment and 25 in-patients who received polytherapy treatment of risperidone and other second-generation antipsychotics were included. Changes in thyroid hormone levels after treatment were retrospectively analyzed. RESULTS: After risperidone monotherapy treatment, serum levels of free thyroxine (FT4) and total thyroxine (TT4) significantly decreased, and serum TSH levels significantly increased (changes from baseline: FT4: median －2.52 pmol/L, P<0.001; TT4: －21.17 nmol/L, P=0.012; TSH: median 0.49 mIU/L, P=0.001). After risperidone polytherapy treatment, serum levels of free triiodothyronine (FT3), total triiodothyronine (TT3) and FT4 significantly decreased, and serum TSH levels significantly increased (changes from baseline: FT3: median －0.37 pmol/L, P=0.001; TT3: median－0.17 nmol/L, P=0.008; FT4: median －2.25 pmol/L, P<0.001; TSH: median 0.97 mIU/L, P=0.029). After risperidone monotherapy treatment, moderately positive relation was found between changes in serum TT4 levels and average daily dose of risperidone. No statistical difference was found on the incidence of subclinical thyroid dysfunction between the two therapeutic regimen (6.9% vs. 12.0%, P=0.862). CONCLUSION: To avoid other disease caused by abnormal thyroid hormone levels, changes in serum thyroid hormone levels should be noticed after risperidone treatment.