氯氮平与氟伏沙明合并治疗精神分裂症的研究

Study of combining fluvoxamine and clozapine to treat schizophrenia

目的研究氯氮平与氟伏沙明合并治疗精神分裂症时的疗效及副作用,为临床更加合理的用药提供依据。方法选取符合CCMD-3诊断标准的,有需要合并应用氯伏沙明的症状的精神分裂症病人30例。单一应用氯氮平,逐渐调整剂量到200～250mg/D,稳定一周后于清晨6时采取患者肘静脉血测定血浆胰岛素、泌乳素水平。并于当日加用氟伏沙明50mg/D。在合并用药后的第4周清晨6时采取患者肘静脉血测定胰岛素、泌乳素水平。合并用药前后测定空腹血糖、血脂、肝功能、心电图。结果合并用药前和合并用药第四周胰岛素、泌乳素异常人数之间无显著差异。合并用药前后空腹血糖异常、心电图异常(除心率)人数无显著差异。合并用药前后肝功能异常、血脂异常、心率异常人数有显著增多。结论建议合并用药时在动态监测氯氮平浓度的情况下结合临床表现及时调整药物用量。合并用药后肝功能异常、心率异常、血脂异常人数有增加,程度较轻不影响治疗。

Objective To study the effect and deleterious effects during combining fluvoxamine and clozapine in treatment of schizophrenia, to be more reasonably using drugs in future. Methods We choosed 30 schizophrenic patients which were diagnosed with the 3rd edition of Chinese classification and diagnostic criteria for mental disorders （CCMD-3） and need using anti-depressive drug. Clozapine was used to 200-250mg/D, one week later at 6 we took the elbow vein blood 5ml to determined plasma insulin, prolactin level. Then we used fluvoxamine 50 mg/D to these patients that evening, At the 4th week at 6 we took the elbow vein blood 5ml to determine plasma insulin, prolactin level Before and after combing fluvoxamine and clozapine we detected blood glucose, blood lipid, liver function, ECG. Results The population that the insulin, prolactin, blood sugar exceeded the high level hadn＇t significantly distinction before and after combining fluvoxamine and clozapine. The population of EKG （heart rate free） abnormal hadn＇t significantly distinction before and after combining fluvoxamine and clozapine. The population that liver function, blood lipid, heart rate exceeded the high level had significantly distinction before and after combining fluvoxamine and clozapine. Conclusion We suggest adjusting clozapine quantity according to the plasma clozapine level and clinical symptom after combing fluvoxamine and clozapine. The population that liver function, heart rate, blood lipid exceeded the high level had significantly distinction after combining fluvoxamine and clozapine, but the abnormal wasn＇t severe and didn＇t affect treatment.