喹硫平、利培酮治疗精神分裂症的1年随访

Quetiapine and risperdal in the treatment of schizophrenia:an one-year follow up study.

目的比较喹硫平与利培酮长期治疗首发精神分裂症患者的疗效及不良反应。方法研究纳入符合国际疾病分类第十次修订本(ICD-10)精神分裂症或分裂样精神障碍研究用诊断标准的首次发病患者262例,喹硫平组和利培酮组各131例,开放性治疗12个月。疗效评估:以两药的停药率、持续治疗时间为主要指标,阳性与阴性症状量表(PANSS)减分及减分率为次要指标,PANSS总分减分率≥50%为显效,25%～50%为有效,<25%为无效。以副反应量表(TESS)、锥体外系副反应量表(RSESE)、不自主运动量表(AIMS)评估不良反应。结果①停药率:喹硫平组33.6%,利培酮组35.2%;持续治疗时间:喹硫平组为(9.49±3.83)个月,利培酮组为(9.52±3.84)个月;复发时间:喹硫平组(3.29±2.34)个月,利培酮组(5.11±2.77)个月;两药的停药率、持续治疗时间、复发时间差异无统计学意义(P>0.05)。②治疗第2、6、12个月末时,喹硫平组治疗有效率分别为78.6%(103/131)、86.2%(113/131)、89.3%(117/131),利培酮组有效率为82.4%(108/131)、87.7%(115/131)、85.5%(112/131),二者的总体疗效相当(P>0.05)。③不良反应:利培酮引起的锥体外系不良反应如静坐不能、肌强直、震颤较喹硫平高(2=14.94,P<0.05),喹硫平组的头晕和晕厥发生率高于利培酮组(2=10.08,P<0.05)。结论喹硫平和利培酮对首发精神分裂症急性期和长期治疗疗效肯定,两药疗效相当,两药不良反应各有特点但均可耐受。

Objective To study the efficacy and adverse effects of quetiapine and risperdal in the long-term treatment of patients with first-episode schizophrenia. Methods This was an open-label ease-control study. Two hundred sixty two patients with first-episode schizophrenia met the diagnostic criteria of ICD-10 were recruited. Patients were randomly di- vided into two groups with 131 patients in each group which received either quetiapine or fisperdal for 12 months. The rate of all-cause treatment discontinuation and time to discountinuation and the rate of reduction in Positive and Negative Syndrome Scale （PANSS） was evaluated. The rate of reduction in PANSS score≥50% was defined as much imporved, 〈 50% and /〉25% was improved, and 〈25% was no change, Treatment Emergent Sympiom Scale （TESS） , Rating Scale for Extrapyramidal Side Effects （RSESE） and Abnormal Involuntary Movement Scale （AIMS） were performed to evaluate adverse effects. Results ①The rate of treatment discontinuation of quetiapine and risperdal groups were 33.6% and 35.2% , respectively. The duration of treatment of quetiapine and risperdal groups were （9. 49 ± 3.83 ） and （9. 52 ±3.84） months respectively. The duration to relapse of quetiapine and risperdal groups were （3.29 ±2. 34） and （5. 11 ±2. 77） months, respectively. There were no significant differences in the rate of treatment discontinuation, the duration of treatment and the duration to relapse between two groups（P 〉 0. 05 ）. ②The response rates at the end of 2, 6, 12 months were 78.6% （ 103/ 131 ）, 86. 2% （ 13/131 ） and 89. 3% （ 117/131 ） in quetiapine group, and 82.4% （ 108/131 ）, 87.7% （ 115/131 ） and 85.5% （ 112/131 ） in risperdal group, respectively. The global efficacy of quetiapine was similar to that of risperdal（P 〉 0. 05）. ③Adverse effects ： The rate of extrapyramidal side effects induced by risperdal, such as akathisia, muscle rigidity and tremor, was higer than that of quetiapine （ χ^2 = 14. 94, P 〈 0. 05 ）. The rate of dizziness induced by quetiapine was higer than that of risperdal（χ^2 = 10. 08,P 〈 0. 05 ）. Conclusions Both quetiapine and fisperdal are effective in the acute phase of first-episode schizophrenia as well as long-term treatment. The efficacy of quetiapine is similar to that of risperdal. Although there is significant difference in the adverse effects between quetiapine and risperdal.