氯氮平联合盐酸丁咯地尔对首发精神分裂症患者局部脑血流与认知功能的影响

Effect of clozapine combined with buflomedil hydrochloride on cerebral blood flow and cognitive function in patients with first episode schizophrenia

目的探讨氯氮平联合盐酸丁咯地尔对首发精神分裂症患者局部脑血流与认知功能的影响。方法选择2013年7月至2014年7月乌鲁木齐市第四人民医院收治的首发精神分裂症患者80例，根据随机数字表法分为观察组和对照组，各40例。2组均给予氯氮平治疗，初始剂量为5mg／d，48h后根据患者自身情况逐渐加量，剂量5—25mg／d。在给予氯氮平治疗的基础上，观察组静脉滴注盐酸丁咯地尔150mg／d，对照组静脉滴注0．9％氯化钠注射液，2组均治疗5周。比较2组局部脑血流[放射性计数比值（RAR）]、认知功能、简明精神病评定量表（BPRS）评分、疗效及不良反应发生情况。结果治疗5周后，观察组左额叶，左、右颞下，左、右基底节，左、右丘脑RAR均明显高于对照组[（0．95±0．09）比（0．76±0．10）、（0．65±0．09）比（0．59±0．06）、（0．66±0．06）比（0．60±0．04）、（0．60±0．09）比（0．52±0．05）、（0．60±0．06）比（0．51±0．06）、（0．39±0．09）比（0．32±0．05）、（0．40±0．06）比（0．33±0．04）]，差异均有统计学意义（均P〈0．05）。治疗前，2组认知功能差异无统计学意义（P〉0．05）。治疗后，2组语言量表、操作量表、全量表、记忆量表、BPRS评分均明显高于治疗前[观察组：（81±8）分比（70±7）分、（80±6）分比（67±9）分、（80±9）分比（70±8）分、（77±11）分比（68±10）分、（25．2±2．6）分比（40．2±6．4）分；对照组：（77±5）分比（70±8）分、（74±7）分比（67±8）分、（75±7）分比（70±7）分、（71±9）分比（67±7）分、（3I．2±5．2）分比（41．6±6．0）分]，且观察组明显高于对照组，差异均有统计学意义（均P〈0．05）。治疗5周后，观察组总有效率明显高于对照组[87．5％（35／40）比75．0％（30／40）]，差异有统计学意义（x2=8．345，P〈0．05）。所有患者均存在三酰甘油升高、体质量升高、嗜睡、便秘等不良反应，观察组和对照组副反应量表评分比较[（2．2±2．6）分比（2．1±2．0）分]，差异无统计学意义（P〉0．05）。结论氯氮平联合盐酸丁咯地尔可改善精神分裂症患者局部脑血流和认知功能。

Objective To investigate the effect of clozapine combined with buflomedil on cerebral blood flow and cognitive function in patients with first episode schizophrenia. Methods Totally 80 patients with first episode schizophrenia from July 2013 to July 2014 were randomly divided into observation group and control group （40 cases in each group）. Both groups were given clozapine for 5 weeks （initial dose was 5 mg/d, then was gradually increased to 5-25 mg/d according to the patient＇s situation 48 h later）. Intravenous drip of builomedil （ 150 mg/d） and 0. 9% sodium chloride injection was additionally given in observation group and control group, respectively. The treatment lasted for 5 weeks. The local cerebral blood flow [ radioactive count ratio （RAR） ] , cognitive func- tion, brief psychiatric rating scale （BPRS） scores, curative effect and adverse reactions were compared between groups. Results After 5 weeks of treatment, the RAR of left frontal lobe, left and right temporal lobe, left and right basal ganglia, left and right thalamus in observation group were significantly higher than those in control group [（0.95 ±0.09） vs （0.76±0.10）, （0.65 ±0.09） vs （0.59±0.06）, （0.66 ±0.06） vs （0.60±0.04）, （0.60±0.09） vs （0.52±0.05）, （0.60 ±0.06） vs （0.51 ±0.06）, （0.39 ±0.09） vs （0.32±0.05）, （0. 40 ± 0. 06） vs （0. 33 ± 0. 04 ） ] （P 〈 0. 05 ）. Before treatment, the cognitive function was not significantly different between groups （ P 〉 0. 05 ） ; after treatment, the scores of language scale, operating scale, full scale, memory scale and BPRS were all significantly higher than those before treatment in observation group I （81 ± 8 ） scores vs （70 ± 7 ） scores, （ 80 ± 6） scores vs （67 ± 9 ） scores, （80 ± 9 ） scores vs （ 70 ± 8 ） scores, （77 ± 11 ） scores vs （ 68 ± 10） scores, （ 25.2 ± 2. 6 ） scores vs （40. 2 ± 6.4 ） scores ] and control group [ （ 77 ± 5） scores vs （70±8） scores, （74 ±7） scores vs （67 ±8） scores, （75 ±7） scores vs （70±7） scores, （71± 9） scores vs （67 ± 7） scores, （ 31.2 ± 5.2） scores vs （41.6 ± 6. 0） scores ] , and in observation group, these scores were more higher （ P 〈 0. 05 ）. After 5 weeks of treatment, the total effective rate in observation group was significantly higher than that in control group [87. 5% （35/40） vs 75.0% （30/40） ] （X2 =8. 345, P 〈0. 05）. The adverse reactions, such as increasing of triacylglycerol and body mass, drowsiness, constipation were observed in both groups, but the score of side effects rating scale showed no significant difference between groups [ （2.2 ± 2. 6） scores vs （2. 1 ± 2.0） scores ] （ P 〉 0.05 ）. Conclusion Clozapine combined with buflomedil can dilate the vessels of ischemic lesions, improve the blood circulation and regional cerebral blood flow, thus enhance the cognitive function in patients with schizophrenia.