四种新型非典型抗精神病药治疗急性期精神分裂症的对照研究

A comparative study of four new atypical antipsychotics in the treatment of acute-episode schizophrenia

目的评价奥氮平、利培酮、阿立哌唑和喹硫平治疗首发精神分裂症的疗效和安全性。方法将114例精神分裂症急性发作的患者随机分为奥氮平组(n=28)、利培酮组(n=33)、阿立哌唑组(n=20)和喹硫平组(n=33),观察疗程6周。在治疗前及治疗后第2、4、6周末采用阳性阴性症状量表(PANSS)、副反应量表(TESS)评定其疗效及药物不良反应。结果治疗后2周奥氮平组、利培酮组PANSS总分显著下降(P<0.01),治疗后4、6周各组的PANSS总分均有显著下降(P<0.01)。利培酮组的主要不良反应为锥体外系不良反应(EPS)、失眠、便秘、月经紊乱等;奥氮平组的主要不良反应为嗜睡、便秘、体重增加及肝功能异常;阿立哌唑组的主要不良反应为锥体外系不良反应(EPS)、失眠、兴奋激越;喹硫平组的主要不良反应为嗜睡、肝功能异常。结论奥氮平、利培酮、阿立哌唑和喹硫平治疗精神分裂症急性发作的疗效相当,其中奥氮平、利培酮起效较快,四种药物不良反应总体较轻。

Objective The study was designed to evaluate the efficacy and safety of olanzapine, risperidone, aripiprazole and quetiapine in hospitalized patients with acute-episode schizophrenia. Methods 114 patients met the ariteria of schizoplneria in CCMD- 3 were randomized into olanzapine＇ group （n = 28）, risperidone group （n=33）, aripiprazole group （n=20） and quetiapine group （n=33） for a 6-week treatment. The efficacy and side effects were assessed with the Positive and Negative Syndrome Scale （PANSS） , Treatment Emergent Symptom Scale （TESS） at the baseline and the end of the 2nd, 4th and 6th week of treatment. Results Both risperidone and olanzapine groups demonstrated a significant decrease in PANSS score （P〈0.01） at the end of 2nd week of treatment. All the four groups showed a significant decrease in PANSS score at the end of 4th and 6th week of treatment （P〈0. 01）. The common adverse events were extrapyremidal symptoms, insomnia, constipation and menstrual disorder in risperidone group, and somnolence, constipation, abnormal liver function and body weight increasing in olanzapine group, and extrapyremidal symptoms, insomnia, excitement and agitation in aripiprazole group, and somnolence, abnormal liver function in quetiapine group. Conclusion Olanzapine, risperidone,aripiprazole and quetiapine are similarly effective in improving the symptoms in patients with acute-episode schizophrenia. The onset of the efficiency of olanzapine and risperidone is faster than quetiapine and aripiprazole. The adverse events of the four atypical antipsychotics is not serious in general.