氨磺必利与氯氮平对阴性症状为主的精神分裂症患者临床疗效及生活质量的对照研究

Comparative study on efficacy and quality of life of amisulpride and clozapine in schizophrenia with predominantly negative symptoms

目的 探讨氨磺必利与氯氮平对以阴性症状为主的精神分裂症的疗效及对生活质量的影响.方法 对70例以阴性症状为主的精神分裂症患者,按抛币法随机分两组,分别用氨磺必利与氯氮平治疗,疗程12周.于治疗前及治疗后1,2,4,8,12周末采用阴性症状量表（SANS）、简明精神病量表（BPRS）评定临床疗效,副反应量表（TESS）评定药物副反应,治疗前及治疗后采用生活质量综合评定问卷（GQOLI-74）评定生活质量.结果 最后一次评定,氨磺必利组BPRS总分降至（30.68 ±4.62）分,与治疗前比较差异有统计学意义（P＜0.01）;氯氮平组BPRS总分降至（31.31 ±4.78）分,与治疗前比较差异有统计学意义（P＜0.01）.两组间疗效差异无统计学意义（P＞0.05）.经12周治疗,氨磺必利组SANS的情感淡漠、思维贫乏、意志缺乏、兴趣社交缺乏、注意障碍各因子分为（12.31 ±4.43）分、（9.66±3.07）分、（8.91±2.56）分、（10.29±2.68）分、（5.58±1.43）分;氯氮平组分别为（14.62 ±4.27）分、（9.32±2.81）分、（8.22±2.60）分、（9.54±2.67）分、（6.62±1.59）分.两组患者阴性症状的改善较治疗前均有显著改善（P ＜0.01）,但氨磺必利组在情感淡漠及注意障碍因子方面的疗效优于氯氮平（P＜0.05）.氨磺必利组和氯氮平组GQOLI-74的物质生活、躯体健康、心理健康和社会功能四个维度得分差异无统计学意义（P＞0.05）.两组患者生活质量较治疗前均有显著改善（P＜0.01）,但在躯体健康、心理健康和社会功能三维度,氨磺必利优于氯氮平（P＜0.01）.氯氮平组副作用比氨磺必利组多.结论 氨磺必利对以阴性症状为主的精神分裂症有肯定的疗效,与氯氮平相当.但在改善情感淡漠、注意障碍和提高生活质量方面优于氯氮平,安全性更高.

Objective To investigate the influence on efficacy and quality of life of amisulpride in schizophrenia with predominantly negative symptoms.Methods Seventy cases of schizophrenia with predominantly negative symptoms were randomly assigned to amisulpride group and clozapine group for 12weeks.The clinical efficacy and side effects were evaluated with SANS,BPRS and TESS before and 1,2,4,8,12 weeks after treatment respectively. GQOLI-74 were used to evaluate the patients＇ quality of life before and after drug administration.Results For the last assessment,the score of BPRS decrease to 30.68 ±4.62 in amisulpride group,was significantly lower than the beginning（P〈0.01 ） ; the score of BPRS decrease to 31.31 ±4.78 in clozapine group,was significantly lower than the beginning （P 〈 0.01 ）.Two groups showed similar effects,with no significance.12weeks after treatment,the scores of emotional dull,poverty of thought,volition abulia,interest-social lack,attention dysfunction in amisulpride group were 12.31 ± 4.43,9.66 ± 3.07,8.91 ± 2.56,10.29 ± 2.68,5.58 ± 1.43 ; and the scores of emotional dull,poverty of thought,volition abulia,interest-social lack,attention dysfunction in clozapine group were 14.62 ± 4.27,9.32 ± 2.81,8.22 ± 2.60,9.54 ± 2.67,6.62 ± 1.59,and the efficacy of amisulpride in emotional dull and attention dysfunction were better than those of clozapine.And the scores of material life,physical function,psychological function,social function in amisulpride group were not higher than those in clozapine group（P〉 0.05）.And the scores of four domains in GQOLI-74 had been improved significantly in two groups（P〈0.01）.The domains of physical function,psychological function,and social function in amisulpride was superior to clozapine（P〈0.01）.The side effects were more in clozapine group than those in amisulpride group.Conclusion Amisulpride is as effective as clozapine for the treatment of schizophrenia with predominantly negative symptoms,but it has more advantage than clozapine to improve emotional dull,attention dysfunction and quality of life in schizophrenia with predominantly negative symptoms.