Abstract： Objective:To investigate the effect of clozapine on endocrine hormone levels in patients with schizophrenia, and to analyze the factors causing metabolic abnormality.Methods:The clinical data of 102 patients with schizophrenia who received treatment at the Wenzhou Seventh People's Hospital from January 2021 to January 2023 were retrospectively analyzed. All patients were treated with clozapine. They were divided into a normal metabolism group ( n = 76) and a metabolic abnormality group ( n = 26) according to whether or not metabolic abnormality occurred after treatment. The glycolipid metabolism levels, thyroid function, and gonadal hormone levels were recorded and compared between the two groups. Logistic regression analysis was then performed to determine the relevant factors influencing the occurrence of concurrent metabolic abnormality in these patients. Results:After treatment, the levels of triglyceride, low-density lipoprotein, glycosylated hemoglobin, triiodothyronine, and prolactin in patients were all significantly increased compared with those measured before treatment, while estradiol level was significantly decreased compared with that measured before treatment ( t = 2.84, 3.36, 25.35, 3.26, 4.88, -5.76, all P < 0.05). Body mass index, disease duration, and the levels of triglyceride, glycosylated hemoglobin, triiodothyronine, and prolactin in the metabolic abnormality group were significantly higher than those in the normal metabolism group, while the levels of low-density lipoprotein, FT 4, and estradiol in the metabolic abnormality group were significantly lower than those in the normal metabolism group ( t = 4.41, 5.67, 3.20, 4.71, 3.49, 3.97, -4.84, -4.51, -4.25, all P < 0.05). The results of the logistic regression analysis indicated that high body mass index ( OR = 7.410, 95% CI = 1.485-36.988), prolonged disease duration ( OR = 1.385, 95% CI = 1.088-1.764), low low-density lipoprotein level ( OR = 0.003, 95% CI = 0.000-0.453), elevated glycosylated hemoglobin level ( OR = 4.222, 95% CI = 1.067-16.706), decreased FT 4 level ( OR = 0.238, 95% CI = 0.086-0.655), and low estradiol level ( OR = 0.845, 95% CI = 0.726-0.984) were the factors associated with metabolic abnormality (all P < 0.05). Conclusion:The use of clozapine in the treatment of schizophrenia will affect the patient's glycolipid metabolism, thyroid function, and gonadal hormone levels. At the same time, it is found that high body mass index, long disease duration, low low-density lipoprotein level, high glycosylated hemoglobin level, low FT 4 level, and low estradiol level will increase the risk of metabolic abnormality in patients. Therefore, targeted interventions should be carried out according to the actual situation.