氯氮平治疗难治性精神分裂症的优化治疗方案

Optimal Treatment Strategies of Clozapine for Refractory Schizophrenia

目的评价氯氮平合并其他抗精神病药物治疗难治性精神分裂症的有效性。方法电子检索Medline、EMBASE、中国生物医学文献数据库等中英文数据库,纳入关于氯氮平合并其他药物治疗难治性精神分裂症的随机、半随机及临床对照试验。依据Cochrane协作网Rev Man 5.3版质量评价标准评价研究质量和提取数据进行Meta分析。结果共47个研究进入Meta分析,分别是与利培酮、阿立哌唑、舒必利、齐拉西酮、无抽搐电休克、丙戊酸盐、碳酸锂合用的研究。分析结果显示：氯氮平联合其他药物治疗难治性精神分裂症的疗效大多优于单用氯氮平组（P均〈0.05）,仅与碳酸锂合用的Meta分析结果显示：试验组和对照组差异无统计学意义（8周：RR=1.27,95%CI=0.82-1.97,P=0.28;12周：RR=1.53,95%CI=0.45-5.13,P=0.49）。结论氯氮平联合其他药物治疗难治性精神分裂症,并不是简单的作用相加,合用可能使神经受体功能甚至生化方面发生有益于健康的生物学变化,从而使精神功能恢复正常,病情得以控制。故针对具体患者对所用的药物做合理配伍,有可能达到提高疗效、减少不良反应的目的,可作为难治性分裂症治疗的策略之一。

Objective To systematically evaluate the efficacy of clozapine combined with other antipsychotic drugs in the treatment of refractory schizophrenia. Methods We searched Medline,EMBASE,and China Biology Medicine databases in both English and Chinese for randomized controlled trials,quasi-randomization controlled trials,and clinical controlled trials concerning the combinations of clozapine with other antipsychotic drugs for refractory schizophrenia. Quality assessment and data extraction were conducted with the Cochrane collaboration＇s Rev Man 5. 3 software. Results Totally 47 trials met the inclusion criteria,in which clozapine was combined with risperidone,aripiprazole,sulpiride,ziprasidone,modified electroconvulsive therapy,valproate,or lithium carbonate,respectively. Analysis showed that most combination strategies were superior to clozapoine alone（ P〈0.05）,except for the combination with lithium carbonate（8 weeks： RR = 1. 27,95% CI = 0. 82-1. 97,P = 0. 28; 12 weeks： RR = 1. 53,95% CI = 0. 45- 5. 13,P = 0. 49）. Conclusion Reasonable combination of clozapine with other drugs may improve the therapeutic effectiveness and reduce adverse reactions and thus can be effectively used for treating refractory schizophrenia.