| 摘要: | 本研究係根據分症病人體內缺乏 n-3 多飽合脂肪酸，進而探討（1）大量補充 omega-3 多飽合脂肪酸可以改善並治分症症；（ 2）分症患者在同的床態下（如嚴重及 藥物治前後），紅血球 omega-3 多飽合脂肪酸與正常對照組之比較； (3) 抗病藥物可改善分症症，並同時影響 omega-3 多飽合脂肪酸之組成。 我們先進之部分開放研究，以明瞭 omega-3 多飽合脂肪酸於華人之效以及副作用特性。第二年，我們發表二例第一年中開放研究的個案（ Reference 1 and 2），我們開始以平組間、雙盲對照之研究設計進八週的實驗。第三，我們共收案分症患者共四十五名，進統計。本研究發現，在飲食攝取方面，病患組總熱攝取顯著高於控制組 (p < 0.05)； 病患之油酸、亞麻油酸、次亞麻油酸及總 飽和脂肪酸攝取顯著高於控制組 (p < 0.05)，其他飽和脂肪酸(包括 EPA 及 DHA) 攝取有低於控制組的趨勢，但無統計上差異。在血漿脂肪酸方面，病患組二十二碳烯酸 (DHA) 百分比顯著低於控制組 (p = 0.010)；紅血球磷脂質脂肪酸方面，病患組 C18:3 n-6 脂肪酸百分比顯著高於控制組，花生四烯酸 (AA) 百分比 (p < 0.05)； 此外，病患組 EPA 及 DHA 百分比呈現低於 控制組的趨勢，但組未達統計上之顯著差異 (p = 0.064 及 p = 0.197)。 在藥物的影響方面， olanzapine 對於 Triglyceride levels, LDL- Cholesterol levels 的升高及 HDL-Cholesterol levels 的下降顯著比 risperdone 的明顯。 在雙盲介入性的研究方面，本研究並沒有發現 omega-3 多飽合脂肪酸有優於對照組的效果，不論在精神病理的評量上，或是其他生化的差異上，兩組均沒有呈現明顯差異。只有在 Triglyceride level 上， omega-3 多飽合脂肪酸有低於對照組的效果。 綜合以上結果，病患飲食脂肪酸攝取差異可能會影響到血液脂肪酸組成，omega-3 多飽合脂肪酸的介入可以改善分症因服用 antipsychotics 造成之血脂及心血管相關的副作用，但對於精神病的測量（病情）並無顯著的效果。本研究無法証實多飽合脂肪酸 (如 AA, EPA 或 DHA) 在慢性穩定的精神分裂症之精神病理上扮演重要的角色，但是否如此仍需更多在急性期的研究証明。
This is a three-year proposal to test the hypothesis that (1) oral administration of omega-3 PUFAs would lead to a therapeutic effect in schizophrenic patients, and (2) the different characteristics of omega-3 PUFA composition could be revealed in different phases of schizophrenia and normal control, and (3) antipsychotic drugs could both relate to clinical improvement and to erythrocyte omega-3 PUFA compositions. In the first and second years, we measured the RBC omega-3 PUFA composition to see if there is any correlation to the different characteristics of patients with schizophrenia. To enhance our experience in omega-3 PUFAs dosing strategies for Taiwanese subjects, we at first conduct a preliminary, open-label study concerning omega-3 PUFAs in the treatment of schizophrenia. We had also conducted the double-blind randomized-controlled trail and collected 24 patients with schizophrenia in the second years. In addition, we published the open-labeled case report in the journal of European Neuropsychopharmacology. For the third year, we recruited 45 patients to evaluate the effect of omega-3 fatty acids on the psychological measurement and lipid profiles. The results showed that BMI and calorie intake of patients were significantly higher than those of control subjects (p < 0.05). Oleic acid, linoleic acid, a-linolenic acid, and total unsaturated fatty acid intake of patients were significant higher (p < 0.05). However, intake of other unsaturated fatty acids, including eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), were lower in patients than in control subjects. Percentage of plasma DHA and erythrocytic arachidonic acid (AA) in patients were significant lower than control subjects (p < 0.05). A lower composition of both EPA and DHA in erythrocytes was also found in schizophrenic patients (p = 0.064 and p = 0.197), however, there were no significant difference. We concluded that the difference in dietary intake of patients could affect blood fatty acid composition. As for the medication effect, we did find that olanzapine had a significant effect on lipid profiles, such as increased triglyceride, LDL-cholesterol, as well as decreased HDL-cholesterol, than risperidone in patients with schizophrenia. We suggested that patients receiving olanzapine should receive more attention on the safety monitoring of lipid changes and cardiovascular diseases. In addition, we found that the intervention of omega-3 fatty acids is not beneficial to these chronic patients, there are no significant changes in the ratings of PANSS, NOSIE, CGI, ESRS, UKU Side-effects Rating Scale. The only effect revealed in this study is that patients in omega-3 group had a lower triglyceride level than patients in placebo group. The specific polyunsaturated fatty acids as AA, EPA or DHA might play an important role in the psychopathology of schizophrenia. However, we did not find the benefit effect on the symptoms of schizophrenia. There might be some benefits in the lipid safety and cardiovascular risk. The patients in our study are relatively chronic. Other study with acute ill patients would be warrant. The outcome of schizophrenia may be improved by education and nutritional intervention in the future. |
