小剂量氨磺必利配合奥氮平对难治性精神分裂患者睡眠及认知功能影响研究
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摘要
目的:探讨小剂量氨磺必利配合奥氮平对难治性精神分裂(TRS)患者睡眠及认知功能的影响。方法:122例TRS患者随机分为对照组和观察组,每组61例。对照组予氨磺必利片100～300 mg·d~(-1),po;观察组在对照组基础上加用奥氮平10～20 mg·d~(-1),po。两组疗程均为12周。比较两组临床疗效、多导睡眠图(PSG)指标、认知功能[精神分裂症认知功能成套测验-共识版(MCCB)]、血清神经损伤因子水平及药品不良反应发生率。结果:对照组总有效率明显低于观察组(75. 41%vs.93. 44%,P <0. 05)。观察组治疗后PSG各项指标均明显优于本组治疗前(P <0. 05)和对照组治疗后(P <0. 05)。治疗后,两组MCCB各项评分均较治疗前显著提高(P <0. 05),血清血清神经生长因子水平、胶质纤维酸性蛋白(GFAP)、同型半胱氨酸(Hcy)水平明显优于治疗前(P <0. 05);且观察组上述各项指标均优于对照组(P <0. 05)。两组药品不良反应发生率差异无统计学意义(P> 0. 05)。结论:小剂量氨磺必利配合奥氮平能明显增加TRS患者睡眠时间,改善客观睡眠质量,提高认知功能,且临床疗效及安全性较高。
Objective: To investigate the effect of low dose amisulpride combined with olanzapine on sleep quality and cognitive function in patients with treatment-resistant schizophrenia( TRS). Methods: Totally 122 patients with TRS were randomly divided into the control group and the observation group with 61 cases in each. The control group was treated with amisulpride tablets,100-300 mg·d~(-1),po. On the basis of the control group,the observation group received olanzapine tablets,10-20 mg · d~(-1),po. The treatment course was 12 weeks. The clinical efficacy,polysomnography(PSG) indices,cognitive function,levels of serum nerve injury factors and incidence of adverse reactions were compared between the groups. Results: The total effective rate of the control group(75. 41%) was lower than that of the observation group(93. 44%),and the difference was statistically significant( P < 0. 05). Compared with those before the treatment and those in the control group,all the PSG indices in the observation group were better( P < 0. 05). After the treatment,MCCB indices in the two groups were all improved significantly( P < 0. 05), the serum levels of nerve growth factor( NGF), glial fibrillary acidic protein( GFAP) and homocysteine( Hcy) were also increased notably( P < 0. 05),and the changes in the observation group were more significant than those in the control group( P < 0. 05). There was no significant difference in the incidence of adverse reactions between the groups( P > 0. 05). Conclusion: Low dose amisulpride combined with olanzapine can significantly increase the sleep time of patients with TRS,and improve the quality of objective sleep and the cognitive function,and the clinical efficacy and safety are promising.
Objective: To investigate the effect of low dose amisulpride combined with olanzapine on sleep quality and cognitive function in patients with treatment-resistant schizophrenia( TRS). Methods: Totally 122 patients with TRS were randomly divided into the control group and the observation group with 61 cases in each. The control group was treated with amisulpride tablets,100-300 mg·d~(-1),po. On the basis of the control group,the observation group received olanzapine tablets,10-20 mg · d~(-1),po. The treatment course was 12 weeks. The clinical efficacy,polysomnography(PSG) indices,cognitive function,levels of serum nerve injury factors and incidence of adverse reactions were compared between the groups. Results: The total effective rate of the control group(75. 41%) was lower than that of the observation group(93. 44%),and the difference was statistically significant( P < 0. 05). Compared with those before the treatment and those in the control group,all the PSG indices in the observation group were better( P < 0. 05). After the treatment,MCCB indices in the two groups were all improved significantly( P < 0. 05), the serum levels of nerve growth factor( NGF), glial fibrillary acidic protein( GFAP) and homocysteine( Hcy) were also increased notably( P < 0. 05),and the changes in the observation group were more significant than those in the control group( P < 0. 05). There was no significant difference in the incidence of adverse reactions between the groups( P > 0. 05). Conclusion: Low dose amisulpride combined with olanzapine can significantly increase the sleep time of patients with TRS,and improve the quality of objective sleep and the cognitive function,and the clinical efficacy and safety are promising.
引文
1陈发展,陆峥.难治性精神分裂症的治疗新方法[J].世界临床药物,2015,36(8):517-519
2谢渭根,张烈,陶涛.阿立哌唑联合氯氮平治疗难治性精神分裂症患者疗效观察[J].浙江中西医结合杂志,2017,27(7):579-581
3夏永兵,杨立身.奥氮平联合氨磺必利治疗难治性精神分裂症的临床效果研究[J].中国当代医药,2015,8(2):123-125
4周勇,陈雪芳,黄汉津.氨磺必利治疗精神分裂症疗效以及安全性研究[J].中国临床药理学与治疗学,2017,22(10):1152-1157
5郭圣兰.氨磺必利与奥氮平治疗难治性精神分裂症疗效比较[J].菏泽医学专科学校学报,2017,29(2):14-16
6何燕玲.阳性与阴性症状量表(PANSS)心理卫生评定量表手册[J].中国心理卫生杂志社,1999,12(增订版):267-276
7赵靖平,施慎逊.中国精神分裂症防治指南[M].第2版.北京:中华医学电子音像出版社,2015:36-42
8 Conley RR,Buchanan RW.Evaluation of treatment-resistant schizophrenia.[J].Schizophrenia Bulletin,1997,23(4):663-674
9 Marder SR,Fenton W.Measurement and treatment research to improve cognition in schizophrenia:NIMH MATRICS initiative to support the development of agents for improving cognition in schizophrenia.[J].Schizophrenia Research,2004,72(1):5-9
10邓新艳.难治性精神分裂症患者的临床特点[J].临床医学研究与实践,2016,1(22):109-110
11李媛媛,张云淑,王健,等.氯氮平治疗难治性精神分裂症的优化治疗方案[J].中国医学科学院学报,2016,38(6):666-678
12刘祖松,徐良雄,曾德志,等.小剂量氨磺必利配合氯氮平治疗难治性精神分裂症[J].中国药师,2016,19(2):308-310
13赵绍锋.奥氮平对精神分裂症患者认知功能障碍的改善作用[J].中国实用神经疾病杂志,2017,20(16):78-80
14刘艳艳,孙凌云.氨磺必利的药理学进展与临床应用评价[J].海峡药学,2016,29(7):187-188
15梁英,刘登堂,司天梅,等.氨磺必利治疗精神分裂症临床应用专家意见[J].中国心理卫生杂志,2017,31(6):425-431
16顾桂英,曾德志,樊学文.精神分裂症患者住院初期睡眠障碍的调查分析[J].湖北科技学院学报(医学版),2013,27(1):61-63
17卢慧贤,曹顺姬,周贤.喹硫平和奥氮平对分裂症睡眠结构的影响[J].中国医药指南,2013,11(19):237-239
18曹爱爱,吴彦,彭代辉.精神分裂症认知功能成套测验在精神科中的应用[J].精神医学杂志,2015,28(4):314-316
19杨月华,项剑虹.帕利哌酮与利培酮治疗首发精神分裂症疗效及对患者机体代谢影响比较[J].药物流行病学杂志,2016,7(7):419-421
20 Chan RCK,Xie W,Geng F,et al.Clinical utility and lifespan profiling of neurological soft signs in schizophrenia spectrum disorders[J].Schizophr Bull,2016,42(3):560
2谢渭根,张烈,陶涛.阿立哌唑联合氯氮平治疗难治性精神分裂症患者疗效观察[J].浙江中西医结合杂志,2017,27(7):579-581
3夏永兵,杨立身.奥氮平联合氨磺必利治疗难治性精神分裂症的临床效果研究[J].中国当代医药,2015,8(2):123-125
4周勇,陈雪芳,黄汉津.氨磺必利治疗精神分裂症疗效以及安全性研究[J].中国临床药理学与治疗学,2017,22(10):1152-1157
5郭圣兰.氨磺必利与奥氮平治疗难治性精神分裂症疗效比较[J].菏泽医学专科学校学报,2017,29(2):14-16
6何燕玲.阳性与阴性症状量表(PANSS)心理卫生评定量表手册[J].中国心理卫生杂志社,1999,12(增订版):267-276
7赵靖平,施慎逊.中国精神分裂症防治指南[M].第2版.北京:中华医学电子音像出版社,2015:36-42
8 Conley RR,Buchanan RW.Evaluation of treatment-resistant schizophrenia.[J].Schizophrenia Bulletin,1997,23(4):663-674
9 Marder SR,Fenton W.Measurement and treatment research to improve cognition in schizophrenia:NIMH MATRICS initiative to support the development of agents for improving cognition in schizophrenia.[J].Schizophrenia Research,2004,72(1):5-9
10邓新艳.难治性精神分裂症患者的临床特点[J].临床医学研究与实践,2016,1(22):109-110
11李媛媛,张云淑,王健,等.氯氮平治疗难治性精神分裂症的优化治疗方案[J].中国医学科学院学报,2016,38(6):666-678
12刘祖松,徐良雄,曾德志,等.小剂量氨磺必利配合氯氮平治疗难治性精神分裂症[J].中国药师,2016,19(2):308-310
13赵绍锋.奥氮平对精神分裂症患者认知功能障碍的改善作用[J].中国实用神经疾病杂志,2017,20(16):78-80
14刘艳艳,孙凌云.氨磺必利的药理学进展与临床应用评价[J].海峡药学,2016,29(7):187-188
15梁英,刘登堂,司天梅,等.氨磺必利治疗精神分裂症临床应用专家意见[J].中国心理卫生杂志,2017,31(6):425-431
16顾桂英,曾德志,樊学文.精神分裂症患者住院初期睡眠障碍的调查分析[J].湖北科技学院学报(医学版),2013,27(1):61-63
17卢慧贤,曹顺姬,周贤.喹硫平和奥氮平对分裂症睡眠结构的影响[J].中国医药指南,2013,11(19):237-239
18曹爱爱,吴彦,彭代辉.精神分裂症认知功能成套测验在精神科中的应用[J].精神医学杂志,2015,28(4):314-316
19杨月华,项剑虹.帕利哌酮与利培酮治疗首发精神分裂症疗效及对患者机体代谢影响比较[J].药物流行病学杂志,2016,7(7):419-421
20 Chan RCK,Xie W,Geng F,et al.Clinical utility and lifespan profiling of neurological soft signs in schizophrenia spectrum disorders[J].Schizophr Bull,2016,42(3):560