利培酮和奥氮平对首发精神分裂症患者治疗前后认知功能的对比观察

Cognitive effectiveness of risperidone and olanzapine in first-episode schizophrenia

目的：观察首发精神分裂症患者部分认知功能领域损害情况以及利培酮和奥氮平对其治疗前后认知功能的潜在作用。方法选取2015年1—10月在新乡医学院第二附属医院住院治疗的57例首发精神分裂症患者和周边社区年龄、性别匹配的30名健康人（健康对照组）,采用随机数字表法将患者分为2组,分别给予利培酮和奥氮平单一治疗。因不良反应难以耐受、药物疗效不佳、换用药物共脱落4例,53例患者完成研究。患者组分别于治疗前和治疗8周后评估患者临床症状（PANSS）和认知功能（连线测试、符号编码、言语记忆、工作记忆、Stroop 测试）,健康对照组仅评估一次。结果 PANSS 减分率对比两组并无显著差异。治疗前,利培酮组和奥氮平组均较健康对照组表现出显著的操作速度、言语记忆（t ＝3．191,t ＝3．743）、工作记忆（t ＝2．151,t ＝2．602）和执行功能领域的差异（P ＆lt;0．05）；经过8周的抗精神病药物治疗,利培酮治疗组表现出连线测试（t ＝3．862, P ＆lt;0．05）、言语记忆领域（t ＝－3．073,P ＆lt;0．05）功能的改善,奥氮平治疗组表现出连线测试（t ＝3．587,P ＆lt;0．05）和工作记忆（t ＝－2．891,P ＆lt;0．05）功能的改善。抗精神病药物剂量与认知功能减分率相关分析发现利培酮服用剂量与患者连线测试减分率呈负相关（r ＝－0．391,P ＝0．048）。结论利培酮和奥氮平对首发精神分裂症患者临床症状和整体认知功能在8周内作用差异无统计学意义,首发精神分裂症患者存在显著的认知功能损害,利培酮和奥氮平能够在改善精神症状的同时一定程度上改善患者的某些认知领域损害,利培酮服用剂量越大,操作速度领域改善情况越差。

Objective To study the impairments of cognitive function in first-episode schizophrenia and the potential effectiveness of risperidone and olanzapine monotherapy on first-episode schizophrenia. Methods A total of 57 first-episode schizophrenia and 30 healthy controls were assessed at baseline, and patients were assessed again after 8-week antipsychotics therapy. Results The positive and negative symptom scale （PANSS） reductive ratio between the two groups was similar. At baseline, the performance of schizophrenia patients was significant poor than healthy controls in the four domains of cognitive function （P 〈 0. 05）; after 8-week′s antipsychotics therapy, the performance of Trail Making Test （t = 3. 862, P 〈0. 05） and Verbal Learning （ t = - 3. 073, P 〈 0. 05） got significant improvements in patients with risperidone, while in group of patients with olanzapine, the performance of Trail Making Test （t = 3. 587, P 〈 0. 05） and working memory domain （t = - 2. 891, P 〈 0. 05） got significant improvements. Spearman correlation analyses suggested that dosage of risperidone was negatively correlated with the score-reducing rate of the performance of Trail Making Test of patients （r = - 0. 391, P = 0. 048）. Conclusions Theeffects of the two psychotroptic drugs on clinical symptoms and cognitive functions are almost equal. Comprehensive cognitive impairment is found in first-episode schizophrenia, and risperidone and olanzapine could partially improve the performance of cognitive function as well as clinical symptoms. The higher the dosage of risperidone is, the less improvement the patients has in the speed of process domain.