可变剂量阿立哌唑、喹硫平与利培酮治疗青少年首发精神分裂症近期疗效与安全性比较

Comparison of Efficacy and Safety of Three Kinds of Atypical Antipsychotics in Adolescent Patients with First-episode Schizophrenia

目的:评价阿立哌唑、喹硫平和利培酮治疗青少年首发精神分裂症的近期疗效及安全性。方法:采用病例对照研究设计,95例精神分裂症患者随机分为阿立哌唑组、喹硫平组和利培酮组,疗程8周。基线和8周末,以阳性和阴性症状量表(PANSS)总分和分量表分变化及有效率为疗效指标,副反应量表(UKU)及锥体外系副反应量表(RSESE)进行安全性评价,同时基线、4周末、8周末测定代谢指标。结果:治疗第8周末,3组药物PANSS总分减分率无显著性差异,利培酮组、阿立哌唑组、喹硫平组PANSS总分分别从治疗前的(89.75±8.50,89.65±9.98,88.63±9.87)减至(53.00±13.37,54.32±16.86,56.81±13.71),3组减分率差异无统计学意义,利培酮组、阿立哌唑组、喹硫平组有效率分别为71.88%,70.97%,68.75%;3组有效率的差异无统计学意义(H=1.284,P=0.526)。不良反应(UKU、RSESE)评估中,3组药物不良反应均为轻、中度,喹硫平组头昏和昏厥发生例数明显多于利培酮组和阿立哌唑组;而利培酮组和阿立哌唑组步态、腿的摆动发生例数明显多于喹硫平组。结论:阿立哌唑、喹硫平和利培酮治疗青少年首发精神分裂症均有效,且3种药物的近期疗效相当,有效率无显著性差异。3组药物不良反应均可耐受,阿立哌唑和利培酮近期不良反应相似,以锥体外系反应为主;而喹硫平组以头昏为主。

Objective：To investigate the clinical efficacy and safety of aripiprazole,quetiapine and risperidone in treatment of the adolescent patients with first-episode schizophrenia.Methods：In the 8-week randomly controlled trial,95 patients with schizophrenia were randomly assigned into aripiprazole group,quetiapine group and risperidone group to receive mono-therapy for 8 weeks.The positive and negative syndrome scale（PANSS）,the Udvalg for Kliniske Unders Lgelser Side Effect Rating Scale（UKU）,rating scale for extrapyramdal side effects（RSESE）were assessed at baseline and 8weeks.Metabolic measures were determined at baseline and again at weeks 4 and 8.Results：At the end of 8weeks,PANSS-total scores in risperidone group,aripiprazole group and quetiapine group decreased from the baseline of（89.75±8.50,89.65±9.98,88.63±9.87）to（53.00±13.37,54.32±16.86,56.81±13.71）,respectively,and there were no statistically significant difference among thcthe groups（F（2.93）=1.028,P=0.362）,and the effective rate were 71.88%,70.97%and 68.75% respectively.There were no significant differences among the three groups（H=1.284,P=0.526）.Of the drug adverse reactions,patients in quetiapine group felt dizziness significantly more than the number of cases in risperidone group and aripiprazole group,while there were significant increase of patients＇ gait and the legs swinging in risperidone group and aripiprazole group than in quetiapine group.Conclusion：Aripiprazole,quetiapine and risperidone are all effective in the treatment of the adolescent patients with first-episode schizophrenia,Their curative effect are similarity.They all have little untoward reaction.Aripiprazole and risperidone have similar untoward reaction short-termly in extrapyramidal symptom,and ouetiapine have untoward reaction mainly in dizziness.