影响氯氮平治疗精神分裂症临床疗效的多因素分析

The multivariate analysis on factors influencing efficacy of clozapine in schizophrenia

目的 探讨氯氮平治疗精神分裂症的临床疗效及其影响因素.方法 对49例精神分裂症患者单一应用氯氮平治疗,于治疗前及治疗1个月末采用简明精神病量表评定临床疗效,统计白细胞水平的动态变化、用药剂量及加药速度、总病程、发病次数、精神症状累计持续时间、病程中的缓解时间、烟酒嗜好、抗精神病药物及成瘾药物使用时间、发病及治疗年龄等资料,逐一进行回归分析.结果 入组患者治疗后简明精神病量表总减分率为76.05%,疗效相对较好的因子依次为激活性、敌对、猜疑、思维障碍、焦虑、抑郁;缺乏活力和自知力障碍因子疗效较差,尤其对自知力障碍的疗效最差.白细胞水平变化对疗效影响最为明显,氯氮平初始剂量和以往抗精神病药物使用时间均是影响临床疗效的相关因素.结论 氯氮平治疗精分症疗效显著,但对自知力恢复效果较差;治疗过程中白细胞水平的变化与疗效显著相关,氯氮平初始剂量和以往抗精神病药物使用时间均是影响临床疗效的相关因素.

Objective To explore clinical efficay and influencing factors of clozapine in schizophrenia. Methods Forty-nine schizophenics were treated with clozaping only, clinical efficaeies were assessed with the Brief Psychiatric Rating Scale （BPRS） before treatment and at the end of 1 month treatment, such informations added up and analyzed regressively in sequence as dynamic changes of leukocyte levels, dosage and speed of increasing dose, total course, onset frequency, accumulative duration of mental symptoms, relieving time during course,, tobacco-wine hobby, using time of antipsychotic and addictive drugs, onset and treating age and so on. Results Total score-reducing rate was 76.05% after treatment, factros having relative better efficacy were in order activation, hostility-suspect, thought disturbance, anxiety-depression; efficacies on activation absence and insight disorder were poorer and that on insight disorder was poorest. The influence of changes of leukocyte levels on efficacy was the most obvious, both initial dose of clozpaine and using time of past antipsychotic were relative factors influencing efficacy. Conclusion Clozapine is effective on schizophrenia,but its effect on insight poor; changes of leukocyte levels during treatment are related to efficacy obviously, both initial dose of clozpaine and using time of past antipsychotic are relative factors influencing efficacy.