2006年我国十省市抗精神病药联合用药情况调查及其影响因素分析

A survey of antipsychotics combination therapy and its related factors in China 2006

目的调查2006年我国10个省市精神分裂症患者抗精神病药联合用药的现状，并初步研究其影响因素。方法按人均国民生产总值，将各省分为5个经济发展等级，以一定的抽样比例，选择10个省市的4l所精神病专科医院或综合医院精神科的5898例精神分裂症住院患者和门诊患者，于2006年5月22-28日使用自制调查问卷进行抗精神病药治疗现况调查。结果（1）4306例（73．0％）患者单独使用1种抗精神病药，其中74例（1．2％）单独使用长效抗精神病药，1237例（21．O％）患者单独使用第1代抗精神病药，2995例（50．8％）患者单独使用第2代抗精神病药，1541例（26．1％）患者联合使用92种抗精神病药。联合用药患者中，291例（4．9％）联用长效抗精神病药与非长效抗精神病药，1250例（21．2％）联用≥2种非长效抗精神病药，其中159例（2．7％）联用92种第1代非长效抗精神病药，741例（12．6％）联用第1代与第2代抗精神病药，350例（5．9％）联用92种第2代抗精神病药。（2）联合用药组震颤、静坐不能、嗜睡、便秘、流涎、口干、体位性低血压、体质量改变、肝功能变化等不良反应的发生比例显著高于单一用药组（P〈0．05）。（3）Logistic回归分析结果显示，门诊或住院治疗、所在地区、年龄、病程（总病程和本次病程）、就诊次数、阴性症状、情感症状、思维奔逸、言语活动增多、攻击以及疾病的严重程度可能为使用联合用药方式的影响因素（P〈0．01）。结论当前我国精神分裂症患者使用抗精神病药以单一用药为主，联合用药方式发生不良反应的风险更高，应当掌握联合用药的适应证；联合用药方式受到多种因素的影响。

Objective To investigate the status quo of the antipsychotics combination therapy application in schizophrenia in China and to identify its influencing factors. Methods Ten provinces and municipal cities were selected based on the same sampling ratio from all provinces that were classified into five economic levels according to per capita gross national product. The investigation was conducted during 22 - 28th May 2006, using the self-compiled questionnaire. Results A total of 5898 patients was recruited from 41 psychiatric hospitals or the department of psychiatry in general hospitals. Among all the patients, 4306 （73.0%） were treated with one antipsychotic medication, including typical 1237 （21.0%）, atypical 2995 （50. 8% ）, and depot antipsychotics 74（ 1.2% ）. A total of 1541 （26. 1% ） patients was prescribed at least two antipsychotics, with 291 （4. 9% ） on a combination of long-acting and short-acting antipsychotics and 1250（21.2% ） on a combination of two or more than two types of short-acting antipsychotics. Within the same group of patients on combination therapy, a total of 159 （2.7%） was prescribed at least two types of typical short-acting antipsychotics, 741 （ 12. 6% ） a combination of typical and atypical antipsychotics and 350 （5.9%） two or more than two types of atypical drugs. Besides, the incidences of adverse events were found to be significantly higher in the combination therapy group than the monotherapy group （P 〈 0. 05 ）, including tremor, akathisia, somnolence, constipation, drooling, dry mouth, orthostatic hypotension, weight change and liver dysfunction. Moreover, logistic regression analysis identified the following factors to be significantly associated with combination therapy, i.e. , outpatient or inpatient treatment, region, age,duration of illness, clinic visits, negative symptoms, affeetive symptoms, flight of thought, increased speech activity, aggressive behaviors and disease severity. Conclusion In China, antipsychotic monotherapy still predominates in the treatment of schizophrenia. The incidence of adverse events is relatively higher in the combination therapy and hence caution should be taken for the indications of the combination therapy. Moreover, the combination therapy could be influenced by a variety of factors.