加味涤痰汤治疗男性精神分裂症患者因利培酮所致高泌乳素血症的疗效及安全性研究

杨金玲　林霜　马彩艳　刘兰英　李亚平

[關键词] 精神分裂症;利培酮;高催乳素血症;加味涤痰汤

[中图分类号] R737.31          [文献标识码] A          [文章编号] 1673-9701（2021）17-0021-04

Efficacy and safety of Revised Di-Tan Decoction in the treatment of hyperprolactinemia caused by risperidone in male schizophrenia patients

YANG Jinling1， 2   LIN Shuang2   MA Caiyan2   LIU Lanying3   LI Yaping1

1.Tongde Hospital affiliated to Zhejiang University of Chinese Medicine， Hangzhou   310012， China; 2.Department of General Medicine， Tongde Hospital of Zhejiang Province， Hangzhou   311100， China; 3.Department of Psychiatry， Tongde Hospital of Zhejiang Province， Hangzhou   311100， China

[Abstract] Objective To investigate the efficacy and safety of Revised Di-Tan Decoction in reducing hyperprolactinemia caused by long-term risperidone in male-schizophrenia patients. Methods A total of 68 male long-term taking risperidone schizophrenia patients in Zhejiang Stand Tongde Hospital（Mental Health Center of Zhejiang Province）from October 2017 to April 2019 were selected and randomly divided into the study group and the control group， with 34 cases in each group. The study group was give risperidone combined Revised Di-Tan Decoction， and the control group was given risperidone therapy. The serum prolactin level， masculine and feminine comprehensive scale （PANSS） and treatment to deal with the adverse reactions were respectively observed and compared before the start of group，at the end of the 4th week of treatment. Results There was no significant difference of serum level of PRL in both the two groups before the start of group（P>0.05）. At the end of the 4th week of treatment， the serum PRL level in the study group was significantly lower than that in the control group， with significant difference（P<0.05）. Moreover， the total score of positive and negative syndrome Scale（PANSS） and negative symptom factor score in the study group at the end of the 4th week of treatment were lower than those in the control group， with significant differences （P<0.05）. At the end of the 4th week of treatment， the serum PRL level， the total score of PANSS and negative symptom factor score in the study group were significantly lower than those before the start of group， with significant differences（P<0.05）. There was no significant statistical difference of adverse reaction between the two groups（P>0.05）. Conclusion Revised Di-Tan Decoction can reduce the prolactin level of hyperprolactinemia caused by long-term use of the second generation of antipsychotic risperidone in patients with schizophrenia， without obvious adverse reaction.

[Key words] Schizophrenia; Risperidone; Hyperprolactinemia; Revised Di-Tan Decoction

抗精神病药物因其对多巴胺受体的抑制作用常导致高泌乳素血症（Hyperprolactinemia，HPRL）[1]，HPRL的标准为男性>20 ng/mL，女性>25 ng/mL[2]。在一般情况下，当血清泌乳素未引起显著临床症状时可以不做处理，但HPRL仍会导致男性勃起功能障碍、乳房增大、泌乳、骨质疏松[3]等发生，极大影响患者的生活质量。高催乳素血症在中医病名上由其引起的症状命名之，“闭经、不孕、溢乳”“男性乳房发育、性功能障碍、阳痿、潮热”等。中医的病理因素“痰”作为上述疾病及癫狂（精神分裂症）的重要致病因素，为当代学者所重视。文献指出，特发性高催乳素血症的主要病机为“脾肾亏虚和肝郁痰凝”，上述病机最终导致冲任失调[4];也有人认为，HPRL所致闭经泌乳综合征乃是久服药物所致脾失运化，痰浊内生，最终导致冲任阻滞[5]。中医的各种方法对降低血清泌乳素水平有一定疗效，且不良反应相对较少[6-7]。而从“痰湿”治疗因抗精神病药物导致的高泌乳血症疗效肯定[8-9]，受到许多学者的关注。本研究旨在探讨在痰湿致病下，研究加味涤痰汤对于降低男性精神分裂症患者因长期使用利培酮所致高泌乳素血症的疗效，以及在联合该药物使用时是否会带来其他的不良反应，从而评估该方剂的安全性，现报道如下。

1 资料与方法

1.1 一般资料

选取2017年10月至2019年4月于浙江省立同德医院（浙江省精神卫生中心）就诊的68例长期服用利培酮的男性精神分裂症患者，将其随机分为研究组和对照组，每组各34例。两组被……