阿立哌唑和利培酮对首发精神分裂症的社会功能及代谢相关指标的对照研究

发布时间：2018-03-02 21:29

本文选题：阿立哌唑　切入点：利培酮　出处：《苏州大学》2013年硕士论文　论文类型：学位论文

【摘要】：目的：探讨阿立哌唑和利培酮对首发精神分裂症的疗效，社会功能，代谢相关指标及体重的影响，以期为临床合理用药提供依据。方法：120例首发精神分裂症患者，按照随机数字表法将其随机分到阿立哌唑组（研究组，60例）和利培酮组（对照组，60例），分别给予滴定剂量的阿立哌唑口腔崩解片（商品名：博思清；成都大西南制药股份有限公司生产，治疗剂量10-30mg/日）和滴定剂量的利培酮片（商品名：维思通；西安杨森制药有限公司生产，治疗剂量2-6mg/日）。于治疗前、治疗4、8、24周末分别应用阳性与阴性症状量表（Positiveand Negative Syndrome Scale，PANSS），个人和社会功能量表（personal and socialperformance scale，PSP），副反应量表（Treatment Emergent Symptom Scale,TESS）评定疗效，社会功能改善情况及药物不良反应；同时检测体重，计算体重指数（Body MassIndex，BMI）。于治疗前、治疗4、8、24周末测定血清代谢相关指标浓度，包括：瘦素（leptin），脂联素（Adiponectin），生长激素释放肽（Ghrelin），胰岛素（Insulin）。同时测定肝、肾功能，血糖，血脂等。采用SPSS17.0统计软件，运用t检验、非参数检验、卡方检验、方差分析等对资料进行分析。有效率比较用Ridit分析。P＜0.05为有统计学意义。结果：1.入组时两组患者在年龄、性别、病程、家族史等方面相似(P＞0.05)。研究组54例，对照组57例完成本次研究（χ2=1.8018，P=0.1795）。 2.至研究终点，研究组有效率66.7%，对照组有效率68.4%.经Ridit分析， R研=0.503， R对=0.488，两组疗效无统计学差异（u=0.275，P＞0.05）。 3.两组的PANSS总分及各因子分在治疗4、8、24周末均较治疗前有显著下降(P＜0.01)。研究组治疗24周末的PANSS总分及各因子分较治疗8周末有显著下降(P＜0.01)，而对照组仅阳性症状分明显下降（P＜0.05）。治疗4、8周末，两组间PANSS总分及各因子分差异无统计学意义（P＞0.05）。治疗24周末，研究组的PANSS总分及阴性症状、一般精神病理因子分低于对照组评分（P＜0.05)。 4.两组在治疗4、8、24周末的PSP总分显著高于治疗前评分(P＜0.01)；各时点组间比较差异均无统计学意义（P＞0.05）。 5.两组均未出现严重不良反应，，没有患者因此而终止治疗，两组不良反应发生率相似(P＞0.05)。 6.两组瘦素浓度在治疗4周末较治疗前均有明显增加（P＜0.05)，且持续至治疗24周末（P＜0.05)；治疗24周末对照组瘦素浓度增加更明显（P＜0.05)。 7.研究组脂联素浓度在治疗8周末较治疗前降低（P＜0.01），治疗4、24周末脂联素浓度与治疗前相似（P＞0.05)；对照组治疗4周末较治疗前降低（P＜0.05），且持续至24周末（P＜0.05）。 8．研究组Ghrelin浓度在治疗8周末较治疗前降低（P＜0.01），并持续至治疗24周末（P＜0.01）。对照组Ghrelin各时点与治疗前相似(P＞0.05)。 9.研究组胰岛素浓度各时点与治疗前相似(P＞0.05)；而对照组胰岛素浓度在治疗24周末较治疗前增加(P＜0.01)。 10．研究组体重及BMI各个时点与治疗前相似（P＞0.05)；而对照组治疗24周末均较治疗前增加(P＜0.05)。结论： 1.阿立哌唑和利培酮治疗首发精神分裂症疗效相似，均能有效改善患者社会功能，为患者回归社会提供了可能。 2.阿立哌唑对患者瘦素、生长激素释放肽浓度的影响更大，但对体重影响不明显。 3.利培酮对瘦素、脂联素、胰岛素浓度影响更明显，可引起体重增加。其引起体重增加的原因也可能与瘦素抵抗（Leptin resistance）及胰岛素抵抗（Insulinresistance，IR）有关。
[Abstract]:Objective: To explore the effect of aripiprazole and risperidone on the first episode schizophrenia, the social function, the metabolism related indexes and body weight, so as to provide evidence for clinical rational drug use.
Methods: 120 patients with schizophrenia were randomly divided into aripiprazole group (60 cases in study group) and risperidone group (control group, 60 cases), were given dose titration of Aripiprazole Orally Disintegrating Tablets (brisking; Southwest Chengdu pharmaceutical Limited by Share Ltd, treatment of 10-30mg/ day) and titrate the dose of Risperidone Tablets (brand Name: Vistone; Xi'an Janssen Pharmaceutical Ltd, dose of 2-6mg/ day). Before treatment, the treatment of 4,8,24 weeks respectively positive and negative symptom scale (Positiveand Negative Syndrome Scale, PANSS), personal and social functioning scale (personal and socialperformance scale, PSP), the reaction volume table (Treatment Emergent Symptom Scale, TESS) to assess the efficacy, social function improvement and adverse drug reaction; at the same time the body weight, body mass index calculation The number of (Body MassIndex, BMI). Before treatment, the treatment of 4,8,24 measured serum indexes of metabolite concentrations, including: leptin (leptin), adiponectin (Adiponectin), growth hormone releasing peptide (Ghrelin), insulin (Insulin). Simultaneous determination of liver, renal function, blood sugar, blood fat and so on. Using SPSS17.0 statistical software using t test, nonparametric test, chi square test and variance analysis are used to analyze the data. The efficiency was compared with Ridit analysis of.P < 0.05 was considered statistically significant.
Results: 1., when entering the group, the two groups were similar in age, sex, course of disease, family history and so on (P > 0.05). 54 cases in the study group and 57 cases in the control group completed the study (chi 2=1.8018, P=0.1795).
From 2. to the end of the study, the effective rate of the study group was 66.7%, and the effective rate of the control group was 68.4%.. After Ridit analysis, R =0.503 and R for =0.488, there was no significant difference between the two groups (u=0.275, P > 0.05).
3. of the two groups of PANSS total score and factor scores of 4,8,24 in the treatment of the weekend was significantly higher than before treatment decreased (P < 0.01). The study group for 24 week PANSS score and each factor score decreased significantly decreased at the end of the 8 week (P < 0.01), while the control group only positive symptom score decreased significantly (P < 0.05). The treatment between the two groups 4,8 weekend, PANSS total score and factor scores were not statistically significant (P > 0.05). After 24 weeks, the study group PANSS total scores and negative symptoms, general psychopathology score score lower than the control group (P < 0.05).
4. the total score of PSP in group 4. was significantly higher than that before treatment (P < 0.01) in the two groups (P < 0.01), and there was no significant difference between each time point group (P > 0.05).
5. the two groups did not have serious adverse reactions, and no patients were terminated, and the incidence of adverse reactions in the two groups was similar (P > 0.05).
6., two groups of leptin concentrations increased significantly at 4 weeks after treatment compared with those before treatment (P < 0.05), and lasted until 24 weeks (P < 0.05). After 24 weeks of treatment, the serum leptin concentration increased more significantly in the control group (P < 0.05).
7., adiponectin concentration in the study group decreased at 8 weeks compared with that before treatment (P < 0.01). The level of adiponectin in treatment group was similar to that before treatment (P < 0.05), while in the control group, the level of adiponectin in the study group was lower than that before treatment (4,24 < 0.01), while that in the control group at 4 weeks was lower than that before treatment (P < 0.05), and lasted for 24 weeks (P < 0.05).
8. the concentration of Ghrelin in the study group decreased at 8 weeks compared with that before treatment (P < 0.01), and lasted until 24 weeks (P < 0.01). The time of Ghrelin in control group was similar to that before treatment (P > 0.05).
9. the time point of insulin concentration in the study group was similar to that before treatment (P > 0.05), while the insulin concentration in the control group was increased at the end of the 24 week treatment (P < 0.01).
10. the time points of body weight and BMI in the study group were similar to those before treatment (P > 0.05), while the control group was increased at the end of 24 weeks than before the treatment (P < 0.05).
Conclusion:
1. aripiprazole and risperidone are similar in the treatment of first episode schizophrenia, which can effectively improve the social function of the patients and provide the possibility for the patients to return to the society.
2. aripiprazole had greater influence on the concentration of leptin and growth hormone releasing peptide (GH) in patients, but the effect on weight was not obvious.
3. risperidone has a more significant effect on leptin, adiponectin and insulin concentration, which can cause weight gain. The cause of weight gain may also be related to leptin resistance (Leptin resistance) and insulin resistance (Insulinresistance, IR).

【学位授予单位】：苏州大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R749.3

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