小剂量阿立哌唑改善第二代抗精神病药物所致高催乳素血症效果研究

Effect of small dose aripiprazole in the treatment of hyperprolactinemia induced by second generation antipsychotics.

目的探讨小剂量阿立哌唑(5 mg/d)治疗第二代抗精神病药物(SGAs)所致高催乳素血症(HPL)的疗效及安全性。方法将40名单用SGAs 4周后出现HPL的精神分裂症女性患者,随机分为干预组及对照组各20例,均维持原治疗方案不变,治疗组加用阿立哌唑5 mg/d,疗程8周。于治疗前及治疗后第4、8周末分别做催乳素和雌二醇的检测、阳性和阴性综合征量表(PANSS)和治疗中需处理的不良反应症状量表(TESS)的评估。结果治疗后第8周末干预组催乳素下降,对照组催乳素上升(P<0.01);干预组雌二醇上升,对照组雌二醇素下降(P<0.05)。经过8周治疗,干预组PANSS总分及各因子分均下降(P<0.01);对照组PANSS总分及阳性症状分、一般病理症状分均下降(P<0.01)。干预组锥体外系不良反应(EPS)发生率低于对照组(P<0.01)。结论对于SGAs所致的精神分裂症女性高催乳素血症患者,阿立哌唑5 mg/d能降低催乳素和减少EPS的发生、升高雌二醇、促进阴性症状的好转。

Objective To explore the efficacy and safety of small dose aripiprazole（ 5 mg/d） in the treatment of hyperprolactinemia（ HPL） induced by second generation antipsychotics（ SGAs）. Methods 40 female schizophrenic patients with HPL induced by 4-week monotherapy of SGAs were randomly divided into study group treated with aripiprazole 5mg / d adjunctively（ n = 20） and control group without adjunctive treatment（ n = 20） for 8 weeks. Serum level of prolactin（ PRL） level and estradiol were measured and all patients were assessed with Positive and Negative Syndrome Scale（ PANSS） and Treatment Emergent Symptoms Scale（ TESS） at baseline and at the end of the 4^（th） ,8^（th） week of the treatment. Results At the end of the 8^（th） week,PRL level decreased significantly in study group and increased significantly in control group（ P〈0. 01）. Estradiol level increased significantly in study group and decreased significantly in control group（ P〈0. 05）. At the end of the 8^（th） week,total score and all factor scores of PANSS in study group decreased significantly（ P〈0. 01）; total score and factor scores of positive symptoms and general psychopathology decreased significantly in control group（ P〈0. 01）. Incidence rate of adverse reaction of extrapyramidal system in study group was lower than that in control group（ P〈0. 01）. Conclusion Small dose aripiprazole（ 5mg / d） adjunctive treatment can reduce PRL and EPS,increase estradiol level and improve negative symptoms in female schizophrenic patients with hyperprolactinemia induced by second generation antipsychotics.