齐拉西酮与利培酮对首发分裂症的疗效及认知功能影响

Control study of Ziprasidone and,Risperidone on Efficacy and Cognitive Function in First-episode Schizophrenia

目的探讨齐拉西酮与利培酮对首发分裂症的疗效和安全性，以及对认知功能影响。方法将符合中国精神疾病分类方案与诊断标准第3版（CCMD-3）分裂症诊断标准的86例首发患者随机分为齐拉西酮组（n1=42）和利培酮组（n=44），分别治疗观察’8周。于治疗前和治疗2、4、6、8周末，用阳性症状及阴性症状量表（PANSS）和不良反应量表（TESS）评定疗效和副反应。用韦氏成人智力量表（WAIS—R）、韦氏记忆量表（WMS）和威斯康星卡片分类测验（WCST）于治疗前后进行认知功能评定。结果两组PANSS总分治疗前后均有显著性差异（P〈0．01），齐拉西酮组有效率92．5％，显效率80％；利培酮组有效率90％，显效率80％，两组疗效无显著性差异（P〉0．05）。治疗6、8周末TESS评分，齐拉西酮组均低于利培酮组，两组有显著性差异（P〈0．01）。两组WAIS—R言语量表、操作量表、全量表和WMS记忆商数及WCST总测验数、持续错误数和随机错误数治疗前后均有显著性差异（P〈0．05或P〈0．01），治疗后两组WMS记忆商数和WCST持续错误数有显著性差异（P〈0．05）。结论齐拉西酮是一种安全有效的非典型抗精神病药物，临床疗效与利培酮相当，并且具有副作用少而轻以及对认知功能的改善明显优于利培酮的特点，可作为治疗精神分裂症的首选药物。

Objective To compare the effect of ziprasidone and risperidone on the efficacy and cogni- tive function in first-episode schizophrenia. Methods 86 first-episode inpatients who met CCMD-3 diagnostic criteria for schizophrenia were randomly divided into study group （ n = 42 ） and control group （ n = 44 ） for an 8- week observation. The study group received ziprasidone, while the control group was treated with risperidone. The Positive and Negative Syndrome Scale （PANSS） and Treatment Emergent Symptoms Scale （TESS） were used to evaluate the efficacy and side effects respectively before and after 2, 4, 6, 8 week~ treatment. WAIS-R, WMS, WCST were adopted to evaluate the cognitive function before and after treatment. Results There were significant difference in the total scores of PANSS of the two group after treatment than before （ P 〈 0. 01 ）. The effective rate of ziprasidone group was 92. 5% , in which 80% were improved remarkably. The effective rate of risperidone group was 90% , in which 80% were improved remarkably. There were significant difference in curative effect between the two groups（ P 〉 0. 05 ）. The scores of TESS of study group were significantly lower than those of control group at 6, 8 weekend （P 〈0. 01 ）. The scores of WAIS-R language scale, operation scale, to- tal scale, memory quotient（MQ） ,total trials, persistent errors and random errors of W CST were improvedsignificantly in two group compared with before treatment （ P 〈 0. 05 or P 〈 0.01 ）. After the treatment, there was remarkable difference on the scores of MQ and persistent errors in study group compared with those in control group （ P 〈 0. 05 ）. Conclusion Ziprasidone is a safe and effective atypical antipsychotics, and it ＇s curative effect is similar to risperidone. However, ziprasidone has few and slight side effects as well as the improvement of the cognitive function of first-episode schizophrenia obviously, it can be used as choice drug for first-episode schizophrenia.