奥氮平治疗儿童精神分裂症临床分析

Effectiveness of olanzapine in the treatment of childhood schizophrenia

目的以氯氮平为对照，探讨奥氮平治疗儿童精神分裂症的疗效与安全性。方法将120例精神分裂症患者按入院顺序随机分成研究组和对照组，各60例。研究组患者服用奥氮平，起始剂量2．5mg／d，第3天添加剂量至5mg／d，此后视病情变化调节剂量，最大不超过15mg／d；对照组患者服用氯氮平，起始剂量12．5mg／d，1周内加到150mg／d，此后视病情变化调节剂量，最大不超过300mg／d。2组患者于治疗前和治疗8周末采用阳性和阴性症状量表（PANSS）和治疗意外症状量表（TESS）评定疗效和不良反应。结果研究组总有效率为73．3％（44／60），对照组总有效率为76．7％（46／60）；2组患者总有效率比较，差异无统计学意义（P〉0．05）。研究组和对照组治疗8周末，PANSS总分较治疗前均降低[研究组：（41．8±13．1）分比（81．2±13．7）分；对照组：（43．2±13．5）分比（79．2±10．5）分]，阳性因子、阴性因子、认知功能、兴奋／激惹和焦虑／抑郁评分均较治疗前明显降低（均P〈0．05）。治疗8周末，研究组阴性因子、认知功能及焦虑／抑郁评分均明显低于对照组[分别为（17．4±7．3）分比（24．7±8．2）分、（3．3±3．4）分比（8．2±4．2）分、（5．1±2．4）分比（8．7±3．1）分]，差异均有统计学意义（P〈0．05或P〈0．01）。研究组主要不良反应为轻度头晕[16．7％（10／60）]、口干[16．7％（10／60）]、体重增加[15．0％（9／60）]等，对照组主要不良反应为唾液增多[40．0％（24／60）]、体重增加[40．0％（24／60）]、轻度头晕[26．7％（16／60）]等，研究组心动过速、嗜睡、血象异常、唾液增多、恶心呕吐、轻度头晕、体重增加、鼻塞、视力模糊、便秘、低血压、食欲增强发生率明显低于对照组（P〈0．05）。结论奥氮平是一种安全、有效的非典型抗精神病药物，可作为治疗儿童精神分裂症的一线用药。但因本研究仅限于12岁以上儿童，且研究时间短、样本量偏少，无法确切反映长时间治疗的疗效，有待于进一步大样本、长时间的研究。

Objective To determine the efficacy and safety of olanzapine in the treatment of childhood schizophrenia by using clozapine as a control. Methods All 60 cases with childhood schizophrenia were randomly divided into research group and control group （n = 60 each group）; The patients in research group took olanzaping with a starting dose 2. 5 mg/d, and the patients in control group took clozaping with a starting dose 12. 5 mg/d. The positive and negative syndrome scale （PANSS） and treatment emergent symptom scale （TESS） were used to evaluate the effect and adverse reaction before and after treatment for 8 weeks. Results There was no significant difference in curative effect between research group and control group [73. 3% （44/60）vs 76.7% （46/60） ,P 〉0. 05]. The scores of PANSS in research group and control group after treatment for 8 weeks were lower than those before treatment [research group： （41.8 ± 13.1）scores vs（81.2 ± 13.7） scores; control group： （43.2± 13.5） scores vs （79. 2 ± 10. 5）scores, all P 〈 0. 05], and the scores of positive factors, negative factors, cognitive function, excitement/irritation and anxiety/depression in two groups after treatment for 8 weeks were lower than those before. treatment. After treatment for g weeks, compared with control group, the scores of negative factors, cognitive± function and anxiety/depression in research group decreased [ （ 17.4 ± 7.3 ） scores vs （ 24. 7 ：± 8.2 ） scores, （ 3. 3 ± 3.4） scores vs （ 8. 2 ± 4. 2 ） scores, （5.1 ± 2.4） scores vs （ 8. 7 ± 3.1 ） scores, respectively, P 〈 0. 05 or P 〈 0. 01 ]. i The adverse reactions were mild dizzy [ 16.7% （10/60） ], thirst [ 16. 7% （10/60） ] and weight gain [ 15.0% （9/60） ] in research group and increased saliva [ 40. 0% （ 24/60 ） ], weight gain [ 40. 0% （ 24/60 ） ], mild dizzy [26.7% （16/60）] in control group. The rates of adverse reaction about tachycardia, drowsiness, abnormal blood picture, increased saliva, nausea and vomitting, mild dizzy, weight gain, nasal congestion, blurred vision, constipation, hypotension, appetite enhancement in research group were lower than those in control group （ all P 〈 0. 05）. Conclusion Olanzapine is a safe, effective agent in the treatment of childhood schizophrenia, and can be used as first-line drug for treatment of childhood schizophrenia.