齐拉西酮联合小剂量奥氮平治疗伴抑郁症状精神分裂症的疗效观察及对脂代谢的影响

Effect and influence on lipid metabolism of ziprasidone combined with low dose of olanzapine in the treat-ment of schizophrenia with depressive symptoms

目的：探讨齐拉西酮联合小剂量奥氮平治疗伴抑郁症状精神分裂症的疗效及其对脂代谢的影响。方法将104例伴抑郁症状的精神分裂症患者按照随机数字表法随机分为两组，治疗组（n＝54例）给予奥氮平，起始剂量为2．5 mg／d，1周内加至5～10 mg／d；齐拉西酮起始剂量为40 mg／d，2周内加至120～160 mg／d。对照组（n＝54例）给予奥氮平，起始剂量为5 mg／d，2周内加至10～20 mg／d；疗程为8周。比较分析两组PANSS总分、HAMD评分，肥胖、血脂等指标变化及不良反应。结果治疗后，治疗组与对照组PANSS总分[（40．19±9．23）比（59．29±10．14）]、HAMD评分[（8．58±3．16）比（12．19±4．04）]均较治疗前显著降低（t＝9．41、4．91、6．51、5．20，均P＜0．05），而治疗组下降更为明显（t＝5．11、3．01，均P＜0．05）；与治疗前比较，对照组治疗后腰围（83．45±5．29）cm、BMI（26．95±2．53）kg／m2均明显升高（t＝5．14、3．18，均P＜0．05），且治疗组治疗后腰围（77．86±3．70）cm、BMI（23．76±2．55）kg／m2均显著低于对照组（t＝5．38、4．53，均P＜0．05）；与治疗前比较，对照组 TC（6．54±0．86）mmol／L、TG（2．26±0．83）mmol／L、LDL-C（3．94± 0．43）mmol／L均明显升高，HDL-C（1．02±0．18）mmol／L明显降低，治疗组TC（5．35±0．58）mmol／L明显升高（t＝4．20、3.27、3．91、2．97、4．47，均P＜0．05）；治疗组治疗后血脂水平均显著优于对照组（t＝3．18、3．01、2.76、2．87，均P＜0．05）；治疗组TESS评分（3．35±0．57）分，显著低于对照组的（4．93±1．03）分（t＝3．98， P＜0．05）。结论齐拉西酮联合小剂量奥氮平治疗伴有抑郁症状的精神分裂症，可有效缓解抑郁症状，且对体质量及血脂代谢的影响小，不良反应少。

Objective To explore the effect of ziprasidone combined with low dose of olanzapine in the treat-ment of schizophrenia with depressive symptoms,and its lipid metabolism.Methods According to the digital table, 108 schizophrenia patients with depressive symptoms were randomly divided into the two groups.The treatment group （n=54）was given starting doses of ziprasidone with 2.5mg/d,increased to 5 -10 mg/d for 1 week.And starting＆nbsp;doses of olanzapine with 40mg/d,increased to 120 -160mg/d for 2 weeks.The control group （n=54）was given starting doses of olanzapine with 5mg/d,increased to 10-20mg/d for 2 weeks.The treatment course was 8 weeks.The PANSS score and HAMD score,indicators of obesity and blood lipid and adverse effect were observed.Results The PANSS score and HAMD score in the treatment group[（40.19 ±9.23）vs （59.29 ±10.14）]and the control group [（8.58 ±3.16）vs （12.19 ±4.04）]were significantly lower than those before treatment（t=9.41,4.91,6.51, 5.20,all P〈0.05）,and the scores in the treatment group were reduced more remarkably（t=5.11,3.01,all P〈0.05）.The waistline（83.45 ±5.29）cm,BMI（26.95 ±2.53）kg/m2,WHR（23.76 ±2.55）cm in the control group were all increased compared with those before treatment（t=5.14,3.18,all P〈0.05）while the indicators[（23.76 ± 2.55）vs （23.76 ±2.55）]above improved more remarkably in the treatment group than those in the control group （t=5.38,4.53,all P〈0.05）.Compared with before treatment,the level of TC （6.54 ±0.86）mmol/L,TG（2.26 ± 0.83）mmol/L,LDL-C（3.94 ±0.43）mmol/L were increased remarkably,and HDL-C（1.02 ±0.18）mmol/L was reduced in the control group,TC（5.35 ±0.58）mmol/L in treatment group in the treatment group （t=4.20,3.27, 3.91,2.97,4.47,all P〈0.05）,while the indicators of blood lipid in the treatment group were better than those in the control group （t=3.18,3.01,2.76,2.87,all P〈0.05）.The TESS score in the treatment group（3.35 ± 0.57）point was lower than that in the control group（4.93 ±1.03）point （t=3.98,P〈0.05）.Conclusion It is effective and safe of combined with low dose of olanzapine in the treatment of schizophrenia with depressive symp-toms,which can contribute to effectively alleviate symptoms of depression with low effect on body weight and blood lip-id metabolism,less adverse reaction.