陈慧,李先萍,李萍,钟丽
CHEN Hui,LI Xianping,LI Ping,ZHONG Li

• 1:内江市第二人民医院精神科

摘要(Abstract)：

目的:观察利培酮和齐拉西酮治疗精神分裂症的临床疗效及糖、脂代谢的影响。方法:170例精神分裂症患者分为利培酮组(88例)和齐拉西酮组(82例),分别给予相应药物治疗8周,比较2组患者治疗前及治疗2、4及8周时的阳性与阴性症状量表(PANSS)评分,比较治疗前及治疗8周时2组患者血糖和血脂水平变,比较2组不良反应。结果:治疗2~8周时,2组PANSS中的阳性症状、阴性症状、一般精神病理评分及PANSS总分均明显低于治疗前(P<0.05或P<0.01),2组比较差异无统计学意义(P>0.05);治疗前2组患者FPG、2 h PG和TC、TG、LDL-C、HDL-C水平比较,差异均无统计学意义(P>0.05),治疗后齐拉西酮组上述指标均无明显变化(P>0.05),而利培酮组FPG、2 h PG和TC、TG、LDL-C水平均明显升高,HDL-C水平明显降低,差异有统计学意义(P<0.05或P<0.01);利培酮组锥体外系反应、体质量增加、月经异常、泌乳、性功能障碍发生率明显高于齐拉西酮组,差异均具有统计学意义(P<0.05或P<0.01)。结论:利培酮和齐拉西酮均可以有效治疗精神分裂症,但长期服用利培酮对患者糖、脂代谢有一定影响,且不良反应发生率高于齐拉西酮。
Objective: To investigate the clinical efficacy and adverse reactions of risperidone and ziprasidone in the treatment of schizophrenia,and analyze its influence on glucose and lipid metabolism.Methods: 170 patients with schizophrenia treated in our department from March 2015 to March 2017 were selected and divided into the risperidone group( n = 88) and the ziprasidone group( n = 82) according to different therapies. The two groups were treated with risperidone and ziprasidone respectively. The mental symptoms of both groups before and 2,4,8 weeks after treatment were compared. The levels of blood glucose and blood lipid were measured and compared between the 2 groups before and 8 weeks after treatment. The adverse reactions of 2 groups were compared. Results: 2 ~ 8 weeks after treatment,the positive symptoms,negative symptoms,general psychopathology scores and PANSS scores of 2 groups were significantly lower than before treatment( P < 0. 05 or P < 0. 01). There was no significant difference between the 2 groups at the same time point( P > 0. 05). After treatment,the levels of glucose metabolism indicators such as FPG,2 h PG and lipid metabolism indicators such as TC,TG,LDL-C,HDL-C had no significant change( P > 0. 05); the levels of FPG,2 h PG and TC,TG,LDL-C in risperidone group significantly increased; the level of HDL-C significantly decreased and the difference between the 2 groups was significant( P < 0. 05 or P < 0. 01). The incidence of extrapyramidal tropism,weight gain,abnormal menstruation,lactation and sexual dysfunction were significantly higher in the risperidone group than those in the ziprasidone group,and the differences were statistically significant( P < 0. 05 or P < 0. 01). The nausea and vomiting,insomnia,drowsiness,decreased visual acuity and sychnosphygmia had no significant difference in the 2 groups( P > 0. 05).Conclusion: Both risperidone and ziprasidone can effectively treat schizophrenia,and alleviate clinical symptoms. The clinical efficacy of both therapies is quite obvious. Long-term use of risperidone has a certain effect upon glucose and lipid metabolism of patients with schizophrenia,and the incidence rate of adverse reactions is higher than ziprasidone. Appropriate antipsychotic drugs should be selected based on the different situation of patients.

关键词(KeyWords)： 精神分裂症;利培酮;齐拉西酮;糖代谢;脂代谢;不良反应
schizophrenia;risperidone;ziprasidone;glucose metabolism;lipid metabolism;adverse reactions

Abstract:

Keywords:

基金项目(Foundation): 四川省德阳市科委项目(2014SZ040)

作者(Author): 陈慧,李先萍,李萍,钟丽
CHEN Hui,LI Xianping,LI Ping,ZHONG Li

DOI: 10.19367/j.cnki.1000-2707.2018.05.019

参考文献(References)：

• [1]钟书铭,郑洪波.精神分裂症流行病学研究进展[J].医学信息,2014,27(23):681-683.
• [2]马厚辉,黄萍,何飞燕,等.齐拉西酮与利培酮治疗女性精神分裂症的对照研究[J].广西医学,2015,37(11):1674-1676.
• [3]张昌,王永柏,杨妍,等.齐拉西酮与利培酮治疗青少年首发精神分裂症的对照研究[J].中国健康心理学杂志,2015,23(11):1604-1607.
• [4]中华医学会精神病学分会.中国精神障碍分类与诊断标准第三版(精神障碍分类)[J].中华精神科杂志,2001,34(3):184-188.
• [5]司天梅,杨建中,舒良,等.阳性和阴性症状量表(PANSS,中文版)的信、效度研究[J].中国心理卫生杂志,2004,18(1):45-47.
• [6]刘治卿.精神分裂症的多递质受体共病假说[J].中国医药指南,2013,11(15):369-370.
• [7]白丽娟,张玉涛,郭娅慧,等.精神分裂症患者脑递质功能与临床症状群的关联研究[J].国际医药卫生导报,2015,21(9):1187-1190.
• [8]姬祥龙,单金凤.利培酮与齐拉西酮治疗精神分裂症的疗效对比[J].中外医疗,2016,35(16):128-129.
• [9]付国柱.传统与新型抗精神病药副反应与预后关系的研究[J].世界中医药,2015,10(2):1452-1453.
• [10]陈统献,闫耀宇,鲍佑元.齐拉西酮和利培酮治疗精神分裂症的临床疗效及安全性评价[J].中国临床药理学杂志,2015,31(10):809-811.
• [11]朱丽荣.齐拉西酮与利培酮治疗女性精神分裂症患者泌乳素水平的比较分析[J].山西医药杂志,2015,44(24):2916-2917.
• [12]黄海燕,潘江艳,韦云龙,等.住院老年精神分裂症患者服用奥氮平和利培酮后对糖脂代谢及认知能力的影响[J].国际精神病学杂志,2016,10(5):797-799.
• [13]杨志.利培酮与齐拉西酮对精神分裂症患者糖脂代谢和细胞因子水平的影响研究[J].中国药房,2014,25(44):4165-4167.
• [14]PARK E J,PARK Y M.The short-term effects of risperidone-induced hyperprolactinemia on lipid metabolism in drug-na6ve children and adolescents[J].Psychiatry Investigation,2015,12(1):55-60.

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