抗精神病药合并盐酸丁咯地尔改善精神分裂症患者阴性症状的疗效

Effect of antipsychotic plus buflomedil hydrochlorde in ameliorating the negative symptoms of patients with schizophrenia

目的:分析抗精神病药并用血管活化剂盐酸丁咯地尔治疗以阴性症状为主的精神分裂症的疗效。方法:选择2003-02/2004-05在中山大学附属第三医院心理科住院的以阴性症状为主精神分裂症患者68例为观察对象。随机分为实验组(n=33)与对照组(n=35),所有患者均使用非典型抗精神病药,包括氯氮平(400～600mg/d)、利培酮(4～6mg/d)、奎硫平(600～1000mg/d)、奥氮平(15～25mg/d),以单一用药为原则;实验组在上述药物外还加用盐酸丁咯地尔150mg/d,静滴,治疗四五周;对照组则在使用抗精神病药外加上安慰剂(生理盐水)治疗。采用简明精神病评定量表、阴性症状量表、阳性症状量表以及副反应量表来评定患者治疗前后症状的改变,用简明精神病评定量表减分率来评价临床疗效。简明精神病评定量表减分率=(基线分-第n次评分)/(基线分-18),规定简明精神病评定量表减分率≥75%为临床无症状;50%≤简明精神病评定量表减分率<75%为显好;25%≤简明精神病评定量表减分率<50%为好转;简明精神病评定量表减分率<25%为无效。结果:68例患者均完成量表评定,全部进入结果分析。①实验组与对照组治疗后简明精神病评定量表、阴性症状量表、阳性症状量表总分值较治疗前均有明显降低;同时治疗后实验组各项指标与对照组相比也有明显下降。(3组量表t=3.486,7.970,3.436,P=0.001,0.000,0.001)。②实验组临床无症状的例数和百分比为5例(15%),显效16例(48%),好转8例(24%),无效4例(12%);而对照组临床无症状的例数和百分比为1例(3%),显效10例(28%),好转16例(46%),无效8例(23%);实验组在治疗4周后的疗效明显高于对照组,差异有显著性(χ2=7.999,P=0.046)。③实验组副反应量表总分较对照组未见明显改变。治疗后两组的副反应主要集中在三酰甘油、体质量增加、嗜睡、便秘方面;但两组之间相比未见明显差异。结论:以阴性症状为主的精神分裂症在使用抗精神病药基础上加用盐酸丁咯地尔后,通过对缺血部位的血管予以扩张,改善血液循环,增加氧和营养物质的供应,使濒于受损或部分受损的神经元得以保存和恢复,而提高临床疗效。且不增加抗精神病药的副反应。

AIM： To analyze the effect of antipsychotic with the vascular activator of buflomedil hydrochlorde on the treatment of negative schizophrenia. METHODS： Sixty-eight schizophrenic patients with negative symptoms, who were hospitalized in the Department of Psychology, the Third Affiliated Hospital of Sun Yat-sen University between February 2003 and May 2004, were randomly divided into study group （n=33） and control group （n=35）. All the patients were treated with atypical antipsychotic, including clozapine （400-600 mg per day）, risperidone （4-6 mg per day）, quetiapine （600-1000 mg per day）, olanzapine （15-25 mg per day）, besides those in the study group were also treated with venous drip of buflomedil hydrochlorde （150 mg per day） for 4-5 weeks, and the patients in the control group were given placebo （saline） besides antipsychotics. The changes of symptoms before and after treatment in all the patients were assessed with brief psychiatric rating scale （BPRS）, scale for the assessment of negative symptoms （SANS）, scale for the assessment of positive symptoms （SAPS） and treatment emergent symptom scale （TESS）. The curative efficiency was evaluated by the decrease scale rating of BPRS. The decrease scale rating of BPRS = （the base score-No n score） /（the base score-18）, and it was regulated that the decrease scale rating 75% was taken as no symptom in clinic, 50% ≤ the decrease scale rating 〈 75% as very much improved, 25% ≤ the decrease scale rating 〈 50% as much improved, and the decrease scale rating 〈 25% as effectless. RESULTS： All the 68 patients finished the scale assessment, and entered the results analysis.① After treatment, the total scores of BPRS, SANS, SAPS in both the study group and control group were obviously decreased as compared with those in the control group, and those in the study group were also markedly decreased as compared with those in the control group （t=3.486, 7.970, 3.436, P=0.001, 0.000, 0.001）.② In the study group, the number of cases and percent of no symptom in clinic was 5 （15%）, very much improved in 16 （48%）, much improved in 8 （24%）, and effectless in 4 （12%）; In the control group, the above were 1 （3%）, 10 （28%）, 16 （46%）, 8 （23%）. The therapeutic effect at 4 weeks after treatment was significantly higher in the study group than in the control group （X^2=7.999, P=0.046）.③The total score of TESS in the study group had no obvious changes as compared with that in the control group. After treatment, the main side effects in the two groups were triglyceride, increase of body mass, drowsiness and constipation, but there were no obvious differences between the two groups. CONCLUSION： For schizophrenia with negative symptoms, the treatment of antipsychotic combined with buflomedil hydrochlorde can expand the vessels at ischemic site, ameliorate blood circulation, increase the supply of oxygen and nutritions, and save and recover the neurons that are to be damaged and some already damaged ones, and then it improves the clinical effect without increasing the side effects of the antipsychotic.