奥氮平与利培酮治疗难治性精神分裂症的对照研究

A comparative study of olanzapine and risperidone in treating patients with treatment-resistant schizophrenia

目的 比较奥氮平与利培酮对难治性精神分裂症的疗效及安全性.方法 68例难治性精神分裂症患者按照排列表法随机分为奥氮平组[34例,（24.1±5.4）mg/d]和利培酮组[34例,（7.9±1.8）mg/d],疗程均为12周.采用阳性和阴性症状量表（PANSS）、临床总体印象量表（CGI）及治疗中需处理的不良反应症状量表（TESS）,在治疗前及治疗第1,2,4,8,12周末分别评定疗效和不良反应.结果 （1）奥氮平组PANSS总分、阳性症状分、阴性症状分及一般病理分均从治疗第2周末起较治疗前下降（P〈0.05～0.01） 利培酮组PANSS总分、阳性症状分、一般病理分从治疗第2周末起,阴性症状分从第4周末起,较治疗前下降（P〈0.05～0.01） 奥氮平组从治疗第2周末起各时点PANSS总分、阴性症状分均低于利培酮组（P〈0.05～0.01）.（2）治疗第2周末起,2组临床总体印象量表-严重程度和改善程度（CGI-SI）总分均较治疗前下降（P〈0.05～0.01） 2组间各时点CGI-SI分的差异无统计学意义（P〉0.05）.（3）治疗第12周末,奥氮平组、利培酮组临床总有效率分别为65%、41%,差异有统计学意义（P〈0.05）.（4）奥氮平组、利培酮组不良反应发生率分别为53%（18/34）和59%（20/34）,差异无统计学意义（P〉0.05） 奥氮平组体质量增加发生率高于利培酮组（P〈0.05） 利培酮组静坐不能、异常泌乳和（或）闭经、肌张力增高的发生率高于奥氮平组（P〈0.05）.结论 奥氮平对难治性精神分裂症有良好疗效,不良反应轻微.

Objective To compare the efficacy and safety of olanzapine and risperidone in treatment of treatment-resistant schizophrenia.Methods A total of 68 patients with treatment-resistant schizophrenia were randomly assigned to olanzapine group and risperidone group, and received olanzapine or risperidone treatment for 12 weeks respectively.The efficacy and adverse events were assessed with the Positive and Negative Syndrome Scale （PANSS）, Clinical Global Impression Scale （CGI） and Treatment Emergent Symptom Scale（TESS） at week 0 and 1,2,4,8,12.Results The PANSS scores in both groups decreased significantly after treatment （P〈 0.05-0.01）.The PANSS total score and negative syndrome score in olanzapine group were significant lower than that in risperidone group at each time point from 2nd weekend after treatment （P〈0.05 - 0.01 ）.The CGI-SI score in both groups decreased significantly after treatment （ P 〈 0.05 - 0.01 ）.The differences in CGI-SI score at each time point in both groups were not significant （P〉0.05）.The response rate was higher in olanzapine group than risperidone group （ P〈0.05）.There were similar rates of side effects between both groups（P〉0.05）, with olanzapine being associated with more weight gain, and risperidone with more akathisia, abnormal lactation and/or menostasia,hypermyotonia.Conclusion The results suggest olanzapine be of good efficacy and less side effects in the treatment of treatment-resistant schizophrenia in comparison with risperidone.