喹硫平利培酮联合氯氮平治疗对难治性精神分裂症患者疗效及血清催乳素水平的影响

Efficacies of quetiapine or risperidone combined with clozapine in the treatment of treatment-resistant schizophrenia and their impacts on serum prolactin

目的探讨喹硫平联合氯氮平与利培酮联合氯氮平治疗难治性精神分裂症的临床疗效和安全性以及对催乳素水平的影响。方法将64例难治性精神分裂症患者随机分为两组，每组32例，研究组口服喹硫平联合氯氮平治疗，对照组口服利培酮联合氯氮平治疗，观察12周。于治疗前及治疗第2周、4周、8周、12周末采用阳性与阴性症状量表、临床总体印象量表评定临床疗效，副反应量表评定不良反应，治疗前及治疗12周末测定血清催乳素水平。结果治疗后两组阳性与阴性症状量表总分及各因子分、临床总体印象量表评分均较治疗前显著下降（P〈0．01），同期研究组较对照组下降更显著（P〈O．05）。治疗12周末，研究组显效率显著高于对照组（x^2=4．00，P〈0．05），总有效率与对照组比较差异无显著性（x^2=0．78，P〉0．05）；研究组治疗各时段副反应量表评分、不良反应发生率及血清催乳素水平均显著低于对照组（P〈O．05或0．01）。结论喹硫平联合氯氮平治疗难治性精神分裂症的临床疗效优于利培酮联合氯氮平治疗，安全性更高，对血清催乳素水平的影响相对较小。

Objective To explore the clinical eificacy and satety ot quetlapme or rlsperlcione commneo wlrn clozapine in the treatment of treatment-resistant schizophrenia and their impacts on serum prolactin. Methods Sixty-four patients with treatment-resistant schizophrenia were randomly divided into two groups of 32 ones each, research group took orally quetiapine plus clozapine and control group did risperidone plus clozapine for 12 weeks. Clinical efficacies were assessed with the Positive and Negative syndrome Scale （PANSS） and the Clinical Global Impression （CGI） and adverse reactions with the Treatment Emergent Symptom Scale （TESS） at baseline and at the end of the 2na, 4~h, 8＇h and 12＇h week treatment, and serum prolactin levels measured at baseline and at the end of the 12~h week. Results After treatment the total and each factor score of the PANSS and the CGI score of both groups lowered more significantly compared with pretreatment （P〈0.01）, do did those in research than in control group contemporaneously （P〈0.05）. At the end of the 12lh week, obvious effective rate was significantly higher in research than in control group （x^2=4.00,P〈0.05）, there was no significant group differences in total effective rate （x^2=0. 78,P〈 0.05） ; the TESS scores, incidences of adverse reactions and serum prolactin levels of all periods were significantly lower in research than in control group （P〈0.05 or 0.01）. Conclusion Quetiapine combined clozapine has more notable efficacy, higher safety and lower impact on serum prolactin compared with risperidone combined with clozapine in the treatment of refractory schizophrenia.