两种用药方案治疗中青年难治性精神分裂的效果与安全性比较

赵斌斌

【摘要】 目的：探討两种不同用药方案治疗中青年难治性精神分裂（SCH）的临床效果与药物安全性。方法：选择2017年6月-2019年12月本院收治的100例中青年难治性SCH患者为研究对象。随机数字表法将其分为对照组和观察组，每组50例。对照组予以氯氮平治疗，观察组应用氯氮平联合阿立哌唑治疗。分析两组患者的治疗效果，同时观察两组血脂代谢、糖脂代谢情况，比较两组患者的用药安全性。结果：观察组的治疗总有效率76.00%，明显优于对照组的42.00%（P<0.05）。治疗前，两组阳性量表、阴性量表、一般精神病理评分比较，差异均无统计学意义（P>0.05）;治疗后，观察组阳性量表、阴性量表、一般精神病理量表评分均低于对照组（P<0.05）。治疗前，两组患者空腹血糖（FBG）、总胆固醇（TC）、甘油三酯（TG）水平比较，差异均无统计学意义（P>0.05）;治疗后，观察组的FBG、TC、TG水平均低于对照组，差异均有统计学意义（P<0.05）。观察组治疗期间失眠、头痛、体质量剧增等不良反应发生率为20.00%，对照组为46.00%，两组比较差异有统计学意义（P<0.05）。治疗前，两组丙转氨酶（ALT）、谷草转氨酶（AST）水平比较，差异均无统计学意义（P>0.05）;治疗后，观察组ALT、AST均低于对照组，差异均有统计学意义（P<0.05）。结论：氯氮平联合阿立哌唑治疗中青年难治性SCH具有理想的治疗效果，同时增加阿立哌唑可减少氯氮平对糖脂代谢、血脂代谢的影响，降低肝功能损伤程度，在联合用药后可显著减少各种不良反应的发生。

【关键词】 难治性精神分裂症 氯氮平 阿立哌唑 精神疾病 不良反应

[Abstract] Objective： To investigate the clinical efficacy and safety of two different drug regimens in the treatment of refractory schizophrenia （SCH） in young and middle-aged adults. Method： A total of 100 middle-aged and young patients with refractory SCH admitted to our hospital from June 2017 to December 2019 were selected as the research objects. They were divided into control group and observation group by random number table method， 50 cases in each group. The control group was treated with Clozapine， and the observation group was treated with Clozapine combined with Aripiprazole. The treatment effects of two groups of patients were analyzed， the metabolism of blood lipid and glucose and lipid in two groups were observed， and the drug safety of two groups of patients were compared. Result： The total effective rate of the observation group was 76.00%， significantly better than 42.00% of the control group （P<0.05）. Before treatment， there were no significant differences in the positive scale， negative scale and general psychopathological score between two groups （P>0.05）. After treatment， the scores of positive scale， negative scale and general psychopathology scale in the observation group were lower than those in the control group （P<0.05）. Before treatment， there were no statistical significance in the levels of fasting blood glucose （FBG）， total cholesterol （TC） and triglyceride （TG） between two groups （P>0.05）. After treatment， the levels of FBG， TC and TG in the observation group were lower than those in the control group， the differences were statistically significant （P<0.05）. The total incidence rate of insomnia， headache， body weight surge and other adverse reactions in the observation group was 20.00%， while that in the control group was 46.00%， the difference between two groups was statistically significant （P<0.05）. Before treatment， there were no significant differences in the levels of alanine aminotransferase （ALT） and aspartate aminotransferase （AST） between two groups （P>0.05）. After treatment， ALT and AST in the observation group were lower than those in the control group， the differences were statistically significant （P<0.05）. Conclusion： Clozapine combined with Aripiprazole in the treatment of refractory SCH in young and middle-aged adults has an ideal therapeutic effect. At the same time， increasing Aripiprazole can reduce the effect of Clozapine on glucose and lipid metabolism and lipid metabolism， reduce the degree of liver function damage， and significantly reduce the occurrence of various adverse reactions after the combination.

[Key words] Refractory schizophrenia Clozapine Aripiprazole Mental illness Adverse reactions

First-authors address： Third Peoples Hospital of Zhaoqing City， Zhaoqing 526060， China

doi：10.3969/j.issn.1674-4985.2021.09.015

精神分裂症（schizophrenia， SCH）属心理疾病，在心理疾病中属于重性精神病，可表现为知觉、感觉、行为多方面的严重障碍，并且随着疾病加重，还可影响患者视觉等感觉感知，导致认知功能、神经功能等系统性疾病的发生[1-3]。临床在治疗SCH中无特效药物，治疗目标是控制疾病相关症状，避免病情持续进展性发展[4-6]。在治疗方式上以药物治疗为主，认知行为干预为辅;其中药物选择安全性较高的非典型抗精神类药物进行治疗。但近年来有报道指出，长期持续使用此类抗精神药物可导致糖、脂类代谢异常，增大心脑血管疾病发生的风险;并且长期应用还需监测肝功能损伤程度，避免诱发肝损伤[7-9]。……