氯氮平联合帕利哌酮治疗难治性精神分裂症疗效及不良反应研究

Efficacy and safety of clozapine combined with paliperidone for the treatment of refractory schizophrenia

目的探讨氯氮平联合帕利哌酮治疗难治性精神分裂症的临床疗效及安全性。方法应用阳性和阴性综合征量表(PANSS)及治疗中需处理的不良反应症状量表(TESS)对单用氯氮平治疗的难治性精神分裂症患者(82例)分别于治疗前后进行评分,将单用氯氮平治疗无效的32例患者改用氯氮平联合帕利哌酮治疗,并用PANSS及TESS量表评定联合治疗前后的疗效及不良反应。结果联合治疗患者在治疗后第8、12周末PANSS总分及各因子分均较治疗前下降(P<0.05),治疗后第12周末有效率为48.62%。单用氯氮平治疗不良反应发生率(62.5%)高于联合治疗(37.5%)(P<0.05),流涎、心动过速、体质量增加不良反应发生率高于联合治疗(P<0.01),而泌乳素升高的不良反应发生率低于联合治疗(P<0.05)。结论氯氮平联合帕利哌酮治疗难治性精神分裂症疗效显著,不良反应较轻,但应用中注意泌乳素水平。

Objective To explore the efficacy and safety of clozapine combined with paliperidone in the treatment of refractory schizophrenia. Methods 82 refractory schizophrenic patients were treated with clozapine monotherapy for 12 weeks in the first stage, and then the 32 ineffective patients were treated with clozapine combined with paliperidone for additional 12 weeks. Positive and negative symptoms scale （PANSS） and Treatment Emergent Symptom Scale （TESS） were used to evaluate the efficacy and side effects. Results Total score and all factor scores of PANSS in 32 patients treated with combination therapy decreased significantly at the end of the 8th and 12th week compared with the baseline （ P 〈 0. 05 ）. The effective rate of combination therapy was 48.62%. The incidence rate of side effects of clozapine monotherapy was significantly higher than that of combination therapy （62.5% vs. 37.5% , P 〈 0. 05 ）, especially the salivate, tachycardia and body weight gain （ P 〈 0. 01 ）. But the incidence rate of hyperprolactinemia in clozapine monotherapy was significantly lower than that in combination therapy （ P 〈 0.05 ）. Conclusion Clozapine combined with paliperidone can take satisfactory effect on refractory schizophrenia with less side effects, except for the hyperprolactinemia.