低剂量奥氮平控制抗NMDAR脑炎精神症状的联系分析

Association analysis of low dose olanzapine in controlling mental symptoms of NMDAR encephalitis

目的:分析低剂量奥氮平控制抗N-甲基-D-天冬氨酸受体(NMDAR)脑炎精神症状的联系影响。方法:选取2014年3月至2018年3月间在本院接受治疗的26例抗NMDAR脑炎患者,随机数字表法分成两组,对照组(13例)行常规免疫治疗,观察组(13例)在上述基础上加服低剂量奥氮平,观察患者临床疗效及不良反应状况,治疗前、治疗后1、2周分别采用阴性和阳性症状量表(PANSS)、外显攻击行为量表(MOAS)、护士观察量表(NOSIE)、汉密尔顿焦虑量表(HAMA)及汉密尔顿抑郁量表(HAMD)评判患者精神症状改善情况。结果:观察组患者总有效率为92. 31%,高于对照组的76. 92%,差异有统计学意义(P <0. 05);治疗前,两组患者的MOAS与NOSIE评分比较,差异无统计学意义(P> 0. 05)。治疗后1、2周,两组患者的MOAS与NOSIE评分显著低于治疗前,差异均有统计学意义(P <0. 05)。且治疗后1、2周,观察组患者MOAS与NOSIE评分显著低于对照组,差异均有统计学意义(P <0. 05);治疗前,两组患者的HAMA与HAMD评分比较,差异均无统计学意义(P> 0. 05)。治疗后1、2周,两组患者的HAMA与HAMD评分显著低于治疗前,差异均有统计学意义(P <0. 05)。且治疗后1、2周,观察组患者HAMA与HAMD评分显著低于对照组,差异均有统计学意义(P <0. 05)。结论:持续低剂量奥氮平可显著改善抗NMDAR脑炎患者的精神症状,不良反应较少,但还需要临床更大样本验证。

AIM: To analyze the effect of low-dose olanzapine on the association of psychiatric symptoms in anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis. METHODS: Twenty-six adults with anti NMDAR encephalitis treated in our hospital from March 2014 to March 2018 were divided into two groups randomly. The control group (13 cases) was treated with routine immunotherapy. The observation group (13 cases) was given low dose olanzapine on the basis of the above. The clinical efficacy and adverse reactions of the patients were observed. Negative and positive symptom scale (PANSS), explicit aggressive behavior scale (MOAS), nurse observation scale (NOSIE), Hamilton Anxiety Scale (HAMA) and Hamilton Depression Scale (HAMD) were used to evaluate the improvement of mental symptoms in patients 1 and 2 weeks after treatment. RESULTS: The total effective rate was 92.31% in the observation group, which was higher than 76.92% in the control group. The difference was statistically significant (P<0.05). Before treatment, difference of the MOAS and NOSIE scores of the two groups were not statistically different (P>0.05). At 1 and 2 weeks after treatment, the MOAS and NOSIE scores of the two groups were significantly lower than those before treatment, and the difference was statistically significant (P<0.05). The scores of MOAS and NOSIE in the observation group were significantly lower than those in the control group at 1 and 2 weeks after treatment (P<0.05). Before treatment, difference of the HAMA and HAMD scores of the two groups were not statistically significant (P>0.05). At 1 and 2 weeks after treatment, the HAMA and HAMD scores of the two groups were significantly lower than those before treatment, and the difference was statistically significant (P<0.05). At 1 and 2 weeks after treatment, the HAMA and HAMD scores of the observation group were significantly lower than those of the control group (P<0.05). CONCLUSION: Continuous low-dose olanzapine can significantly improve the psychiatric symptoms of patients with anti-NMDAR encephalitis with fewer adverse reactions, but it requires more clinical validation.