奥氮平与哌醋甲酯治疗儿童多动症效果对照(英文)

Efficacy of olanzapine versus methylphenidate treatment for childhood hyperkinetic syndrome

背景:注意缺陷或多动障碍通常采用精神兴奋类药物治疗,此类药物已经显示对大多数儿童的认知和行为障碍起改善作用。目的:比较奥氮平与哌醋甲酯治疗儿童多动症的临床疗效及不良反应。设计:病例对比观察。单位:北京回龙观医院精神科和山东省牟平县人民医院心理精神科。对象:选择2002-03/2004-04在北京回龙观医院精神科门诊和山东牟平人民医院心理精神科门诊或病房就诊的儿童多动症患儿60例,监护人均知情同意。随机分为2组,奥氮平组及哌醋甲酯组各30例。方法:奥氮平组患儿给予奥氮平2.5～7.5mg/d,晚上1次顿服;哌醋甲酯组给予哌醋甲酯5～15mg/d,分早、午2次口服。两组疗程均为12周。两组患儿于治疗前及治疗第12周末用Conners氏教师用量表(①多动指数项目分10个条目。②多动行为因子项目包括7个条目。每项表现为“无、稍有、相当多、很多”计为0,1,2,3分)、治疗副反应量表(分为行为毒性、化验异常、神经系统、植物神经系统、心血管系统及皮肤症状等。0无,1可疑或极轻,2轻度,3中度,4重度。最高分为22,最低为0,超过2分为阳性)进行多动症状及副反应评估。主要观察指标:两组患儿治疗第12周末多动症状评分及副反应评分。结果:60例患儿全部进入结果分析,无脱落。①两组患儿治疗第12周末多动症状评分比较:治疗12周后,奥氮平组及哌醋甲酯组患儿的多动指数总分及多动行为因子总分均较治疗前显著降低[12.4±2.8,15.1±9.2,13.7±3.4,20.8±10.3;26.6±3.9,43.5±11.7,25.5±4.8,41.6±5.9(t=8.16～15.26,P<0.05～0.01)];且奥氮平组的多动行为因子总分显著低于哌醋甲酯组(t=2.69,P<0.05)。②两组患儿治疗第12周末的副反应评分比较:奥氮平组、哌醋甲酯组患儿的副反应评分分别为10.3±4.5,10.9±3.8,差异无显著性意义(P>0.05)。结论:奥氮平及哌醋甲酯均能显著改善多动症患儿的多动症状和注意缺陷,但奥氮平对行为障碍的总体改善程度要优于哌醋甲酯。

BACKGROUND： Attention deficit and hyperkinetic disorder （ADHD） is frequently treated with psychostimulant medications, which had been shown to improve both cognitive and behavioral outcomes for most children. OBJECTIVE： To compare the efficacy and adverse effects of olanzapine vs methylphenidate treatment in childhood hyperkinetic syndrome. DESIGN： Clinical comparative study. SETTING： Department of Psychiatry, Beijing Huilongguan Hospital; Department of Mental Psychiatry, Shangdong Mouping People＇s Hospital. PARTICIPANTS： Sixty children with hyperkinetic syndrome from the clinics of the Department of Psychiatry, Beijing Huilongguan Hospital and the Department of Mental Psychiatry of Shandong Mouping People＇s Hospital between March 2002 and April 2004 were enrolled into this prospective study after obtaining the consents from their guardians. The patients were randomly divided into 2 group： the olanzapine group （n=30） and the methylphenidate group （n=30）. METHODS： In the olanzapine group olanzapine 2.5-7.5 mg per day was given as a single dose in every evening. In the methylphenidate group methylphenidate 5-15 mg per day was given in divided dose in every morning and evening. The dosage of olanzapine and methylphenidate were adjusted according to age, body mass and patient＇s clinical conditions, and the period of treatment for either drug was 12 weeks. Conners teachers scale was used before and at the end of the 12 week treatment （①hyperkinetic index consisted of 10 items②hyperkinetic behavior factor consisted of 7 items. Each item was rated ＂ none=0, a little=1, quite a lot=2, and very much=3 ）. Side effect scale was used to evaluate the hyperkinetic symptom and adverse reactions which consisted of behavior toxicity, abnormal laboratory tests , symptoms of the nervous system, autonomic nervous system, cardiovascular system and skin etc with. 0=none; 1=suspicious or very mild, 2=mild, 3 =moderate, 4=severe. The highest score was 22, and the lowest was 0 with a score over 2 being positive finding）. MAIN OUTCOME MEASURES： Hyperkinetic syndrom score and adverse reaction score at the end of the 12 weeks treatment. RESULTS： All 60 children completed the study and their resuhs were entered into the data analysis ① At the end of the 12^th week treatment, the total hyperkinetic index score and total behavior score in both the olanzapine group and the methylphenidate group were significantly lower than those before the treatment as shown in Table 1 （t=8.16-15.26, P 〈 0.05-0.01 ）]; The total hyperkinetic behavior score in the olanzapine group was significantly lower than that in the methylphenidate group （t=2.69 P 〈 0.05）. ② The adverse reaction score of patients in the olanzapine group and the methylphenidate group was 10.3＋4.5 and 10.9＋3.8 respectively , with no significant difference （P 〉 0.05） between the two groups. CONCLUSION： Olanzapine produced similar effect as methylphenidate in the treatment of the hyperkinetic symptoms and attention deficits with a better efficacy in treating the behavior disorder than methylphenidate.