氯氮平、氯丙嗪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

A comparison of clozapine to chlorpromazine affecting serum glutamate levels and their relationship with clinical efficacy in schizophrenia

目的 探讨氯氮平、氯丙嗪的疗效与精神分裂症患者血清谷氨酸含量变化间的关系。方法 60例符合条件的精神分裂症患者随机分成两组 ,予以固定剂量的氯氮平和氯丙嗪治疗八周。用简明精神病评定量表 (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)进行评定。治疗前及结束时检测血清谷氨酸含量各一次 ,与正常对照组进行比较。结果 治疗前血清谷氨酸含量氯氮平组 [( 1 1 4± 3 7) μmol/L]、氯丙嗪组 [( 1 1 1± 2 9) μmol/L]均显著低于对照组 [( 1 66± 62 ) μmol/L] ,t值分别是 3 .0 2、3 .2 3 ,P <0 .0 1。治疗后氯氮平组血清谷氨酸含量 [( 1 49± 3 6) μmol/L]较治疗前明显增高 (t =5.86,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 (r =0 .50 2 ,P <0 .0 1 ) ,氯丙嗪组则不。结论 氯氮平能影响谷氨酸能系统 ,这种作用可能与其改善精神分裂症阴性症状的作用相关。

Objective To evaluate the effects of clozapine and chlorpromazine on serum glutamate(Glu) levels and their relationship with the therapeutic effectiveness.Methods Sixty inpatients with schizophrenia were treated with a fixed dose of either clozapine(300mg/d) or chlorpromazine(500mg/d) for 8 weeks in a randomized ,controlled design.The clinical symptoms were assessed using Brief Psychiatric Rating Scale (BPRS),Scale for Assessment of Negative Symptom(SANS),Scale for Assessment of Positive Symptom(SAPS),Wisconsin Card Sorting Test(WCST) at pre and post treatment.The serum Glu levels were measured at baseline and at the end of study.Results At baseline ,the serum Glu levels were significantly lower in the group with schizophrenia than in normal controls.After neuroleptic treatment,serum Glu levels were significantly increased in the clozapine treatment group(t= 5.86 ,P<0.01),but not in the chlorpromazine treatment group. There was a positive correlation between the change of serum Glu levels and the clinical effectiveness in the clozapine treatment group(r=0.502,P<0.01).Conclusion There may be some relevance between the clinical effectiveness of clozapine and the change of serum Glu levels.