随机对照研究比较喹硫平与氟哌啶醇治疗精神分裂症的疗效

Randomized controlled 16-week trial of the effect of quetiapine on the quality of life and cognitive functioning of patients in acute episodes of schizophrenia

目的研究喹硫平对精神分裂症患者认知功能及生活质量的改善作用。方法将62名住院或门诊的急性期精神分裂症患者随机分为两组,分别给予喹硫平(n=32)和氟哌啶醇(n=30)治疗,随访16周。分别在基线、第8周、第12周和第16周用阳性与阴性综合征量表(PANSS)、生活质量和满意度自评问卷(Q-LES-Q)、持续性操作测验(CPT)、威斯康星卡片分类测验(WCST)以及成人韦氏智力量表(WAIS)中的数字广度项目盲法评定精神症状、生活质量和满意度以及认知功能。采用重复测量的方差分析比较两组结果。结果喹硫平组有17例完成16周的随访,氟哌啶醇组为14例。喹硫平组与氟哌啶醇组各时点PANSS评分均比基线改善,组间无明显差异。喹硫平组的4个时点平均(标准差)Q-LES-Q得分改善[分别为:49.0(8.1)分,51.2(7.0)分,54.3(10.6)分,54.1(10.3)分,F=11.70,P<0.001],而氟哌啶醇组无明显改善[分别为:49.5(7.8)分,51.3(8.0)分,50.0(8.7)分,50.5(8.9)分;F=0.33,P=0.701]。在第16周时喹硫平组Q-LES-Q得分高于氟哌啶醇组(t=2.27,P=0.026)。第8周至第16周,喹硫平组WCST完成分类数、CPT的反应时间、WAIS数字广度评分与基线比均明显改善,而氟哌啶醇组的不同时点间评分无明显差异。结论虽然根据PANSS结果,急性精神分裂症患者用喹硫平和氟哌啶醇治疗的疗效相当,但是持续用喹硫平治疗16周者比持续用氟哌啶醇治疗者的生活质量更好,认知缺陷更少。

Background：Comprehensive evaluation of second-generation antipsychotic medications requires assessment of their effects on quality of life and cognitive functioning in addition to the standard assessment of their effect on positive and negative symptoms. Methods： 62 inpatients and outpatients in an acute episode of schizophrenia were randomly assigned to treatment with quetiapine （n=32） or haloperidol （n=30） and followed for 16 weeks. The Positive and Negative Symptoms Scale （PANSS）, self-completion Quality of Life Enjoyment and Satisfaction Questionnaire （Q-LES-Q）, Continuous Performance Test （CPT）, Wisconsin Card Sort Test （WCST）, and the Digit Span Test subtest of the Weschler Adult Intelligence Scale were blindly administered at baseline, 8 weeks, 12 weeks and 16 weeks. Results：17 of the 32 patients （53%） in the quetiapine group and 14 of the 30 patients （47%） in the haloperidol group completed the 16 weeks of treatment. Both groups showed significant improvement over time based on the mean PANSS scores and there were no significant differences in mean PANSS scores between the groups at any time period.However, the mean （sd） quality of life measure improved over the 4 time periods in the quetiapine group [49.0（8.1）,51.2（7.0）,54.3（10.6）,54.1（10.3）; F = 11.70,P 0.001] but not in the haloperidol group [49.5（7.8）,51.3（8.0）,50.0（8.7）,50.5（8.9）;F = 0.33,P = 0.701]. At week 16 the mean quality of life score was significantly higher in the quetiapine group than in the haloperidol group （t = 2.27,P =0.026）. There were also significant improvements in the results of the WCST, CPT, and Digit Span Test from weeks 8 to 16 in the quetiapine group but not in the haloperidol group. Conclusion：Despite similar outcomes based on the PANSS, after 16 weeks of treatment patients with acute schizophrenia who continue on treatment with quetiapine have a better quality of life and less severe cognitive deficits than patients who continue on treatment with haloperidol.