抗精神病药治疗精神分裂症的疗效与血清谷氨酸含量变化的关系

Relationship between therapeutic effect of risperidone,clozapine, chlorpromazine and pre and post treatment changes in glutamate level in patients with schizophrenia

目的 :探讨不同抗精神病药对精神分裂症患者血清谷氨酸含量的影响及其与疗效的关系。方法 :6 0例符合条件的精神分裂症患者随机分成 3组 ,分别给予固定剂量的利培酮、氯氮平和氯丙嗪治疗 8周。用简明精神病量表 (BPRS)、阴性症状评定量表 (SANS)、阳性症状评定量表 (SAPS)、威斯康星卡片分类测验 (WCST)评定临床症状。治疗前、后各检测血清谷氨酸含量 1次 ,同时检测 15例健康志愿者血清谷氨酸含量作为正常对照值。结果 :治疗前血清谷氨酸含量利培酮组 [(10 7± 2 9) μmol/L]、氯氮平组 [(10 0± 30 ) μmol/L]、氯丙嗪组 [(10 5± 2 6 )μmol/L]均显著低于对照组 [(16 6± 6 2 ) μmol/L],P <0 .0 1。治疗后血清谷氨酸含量利培酮组 [(146± 47) μmol/L]和氯氮平组 [(141± 32 ) μmol/L]较治疗前明显增高 (P <0 .0 1) ,且治疗前后血清谷氨酸含量变化值与SANS总分减分率呈正相关 ,氯丙嗪组则不同。结论 :利培酮、氯氮平能影响谷氨酸能系统 。

Objective:To explore the effect of some antipsychiatric drugs on serum glutamate level in relation to therapeutic effects.Methods:60 patients were randomized to receive risperidone,clozapine,and chlorpromazine in specific dose for 8 weeks and their clinical symptoms were assessed using BPRS(Brief Psychiatric Rating Scale), SANS (Scale for Assessment of Positive Symptom),SAPS(Scale for Assessment of Positive Symptom) and WCST (Wisconsin Card Sorting Test).Serum glutamate content (SGC) was determined before and after treatment and normal serum glutamate concentration was obtained from 15 healthy volunteers.Results:The post treatment SGC for all drugs was significantly higher than that of pre treatment except chlorpromazine( P <0.01).The clinical effectiveness was positively correlated with the difference of SGCs in pre and post treatment groups of risperidone and clozapine.Conclusion:Glutamatergic system can be affected by risperidone and clozapine treatment and it may be related to improvement in psychiatric symptoms.