齐拉西酮与奥氮平治疗首发精神分裂症临床疗效评价及糖脂代谢安全性的研究

发布时间：2019-03-25 19:57

【摘要】：目的：比较齐拉西酮和奥氮平对首发精神分裂症患者的疗效和安全性；比较齐拉西酮和奥氮平对首发精神分裂症患者体质量和糖脂代谢的影响；评价心理健康教育对首发精神分裂症患者服药依从性的影响。方法： 80例首发精神分裂症患者被随机分配到齐拉西酮组或奥氮平组,治疗观察6周。于治疗前及治疗后2周末、4周末和6周末使用阳性和阴性症状量表(Positive and Negative Syndrome Scale, PANSS)和临床疗效总评量表-疾病严重程度(Clinical Global Impressions-Severity of Illness scale, CGI-S)评定两种药物的疗效。使用PANSS总分、减分值、减分率和CGI-S总分作为评价药物疗效的主要指标,使用症状好转率和治疗有效率作为次要指标。于治疗前及治疗后2周末、4周末和6周末测量患者的体质量,计算体质量指数；于治疗前后测量记录患者的空腹血糖、空腹胰岛素、低密度脂蛋白、高密度脂蛋白、总胆固醇和甘油三酯,并计算胰岛素抵抗指数。由研究者使用不良事件记录表记录研究过程中出现的所有不良反应。对服用这两种药物的患者实施心理健康教育,评价心理健康教育对患者服药依从性的影响。结果：共79例患者完成研究,齐拉西酮组39人,平均剂量(127.50+27.43)mg/d；奥氮平组40人,平均剂量(19.13+1.92)mg/d。齐拉西酮组和奥氮平组的PANSS和CGI-S评分、症状好转率和治疗有效率的差异均无显著性(P均0.05)。虽然齐拉西酮组更易引起锥体外系不良反应(P0.05),但两种药物均具有较好的耐受性,均未出现严重不良反应。奥氮平组的体质量、体质量指数、空腹血糖、胰岛素、胰岛素抵抗指数和低密度脂蛋白的增加要显著高于齐拉西酮组(P均0.05)。高密度脂蛋白、总胆固醇和甘油三酯在两组内均有升高,但两组的差异无显著性(P均0.05)。患者实施心理健康教育后两者服药依从性均较好(P均0.05)。结论：齐拉西酮和奥氮平对首发精神分裂症患者均具有较好的疗效,并且两种药物的疗效相当。齐拉西酮较易引起锥体外系不良反应,但两种药物均具有较好的耐受性。齐拉西酮对体质量、糖代谢和低密度脂蛋白的影响较小,而奥氮平会显著增加体质量,并且更易导致糖代谢异常和低密度脂蛋白的升高。心理健康教育可显著提高首发精神分裂症住院患者服药的依从性。
[Abstract]:Objective: to compare the efficacy and safety of ziprasidone and olanzapine in the treatment of first-episode schizophrenia, and to compare the effects of ziprasidone and olanzapine on body mass and glucose and lipid metabolism in patients with first-episode schizophrenia. To evaluate the effect of mental health education on drug compliance of first-episode schizophrenic patients. Methods: 80 patients with first-episode schizophrenia were randomly assigned to ziprasidone group or olanzapine group for 6 weeks. Positive and negative symptom scale (Positive and Negative Syndrome Scale, PANSS) and Clinical Global Checklist-Disease severity scale (Clinical Global Impressions-Severity of Illness scale,) were used before treatment and 2 weeks after treatment, 4 weeks and 6 weeks after treatment. CGI-S) was used to evaluate the efficacy of the two drugs. The total score of PANSS, the reduced score, the reduction rate and the total score of CGI-S were used as the main indexes to evaluate the curative effect of drugs, and the improvement rate of symptoms and the effective rate of treatment were used as the secondary indexes. The body mass of the patients was measured before and 2 weeks, 4 weeks and 6 weeks after treatment, and the body mass index was calculated. Fasting blood glucose, fasting insulin, low density lipoprotein, high density lipoprotein, total cholesterol and triglyceride were measured before and after treatment, and insulin resistance index was calculated. All adverse reactions during the study were recorded by the researchers using a log of adverse events. To evaluate the effect of mental health education on the compliance of patients taking these two drugs. Results: a total of 79 patients were enrolled in the study. There were 39 patients in the ziprasidone group, 40 patients in the (127.50 27.43) mg/d; olanzapine group, and the average dose (19.13 1.92) mg/d. in the olanzapine group. There was no significant difference in the scores of PANSS and CGI-S between ziprasidone group and olanzapine group, as well as in the improvement rate of symptoms and the effective rate of treatment (P 0.05). Although ziprasidone group was more likely to cause extrapyramidal side effects (P0.05), both drugs had good tolerance and no serious adverse reactions were observed. The body mass, body mass index, fasting blood glucose, insulin resistance index and low density lipoprotein in olanzapine group were significantly higher than those in ziprasidone group (all P 0.05). High density lipoprotein (HDL), total cholesterol (TC) and triglyceride (TG) were increased in the two groups, but there was no significant difference between the two groups (P 0.05). The compliance of the patients with mental health education was better than that of the control group (P < 0.05). Conclusion: both ziprasidone and olanzapine are effective in the treatment of first-episode schizophrenia, and the curative effects of the two drugs are the same. Ziprasidone is easy to cause extrapyramidal adverse reactions, but both drugs have good tolerance. Ziprasidone had little effect on body mass, glucose metabolism and low density lipoprotein (LDL), while olanzapine significantly increased body mass and was more likely to lead to abnormal glucose metabolism and low density lipoprotein (LDL). Mental health education can significantly improve the compliance of inpatients with first-episode schizophrenia.
【学位授予单位】：中南大学
【学位级别】：博士
【学位授予年份】：2012
【分类号】：R749.3

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