帕利哌酮与奥氮平治疗首发精神分裂症患者的疗效观察

Effect of paliperidone and olanzapine on patients with first-episode schizophrenia

目的:探讨帕利哌酮与奥氮平治疗首发精神分裂症患者的疗效及对糖代谢、血清脑源性神经营养因子(brain-derived neurotrophic factor,BD-NF)浓度的影响。方法:80例首发精神分裂症患者随机分为帕利哌酮组40例和奥氮平组40例,治疗8周。用阳性和阴性症状量表(positive and negative syndrome scale,PANSS)评定临床疗效,用副反应量表(treatment emergent symptom scale,TESS)评估不良反应。于基线期以及第4和8周末检测两组的空腹血糖(fasting blood sugar,FBS),用酶联免疫吸附法(enzyme-linked immuno sorbent assay,ELISA)检测血清BDNF浓度。结果:(1)治疗8周后,帕利哌酮组总有效率68.4%,与奥氮平组的63.1%相似(P>0.05);(2)两组在治疗4周、8周末的PANSS总分及各因子分均较基线期有明显降低(P<0.05),组间阳性和阴性症状评分差异无统计学意义(P>0.05);(3)组内相比,奥氮平组8周末FBS水平较4周末明显升高,差异有统计学意义(P<0.01),而帕利哌酮组差异无统计学意义(P>0.05);组间比较,8周末奥氮平组FBS水平较帕利哌酮组明显升高,差异有统计学意义(P<0.01);(4)与基线期相比,治疗4、8周末两组BDNF浓度均有明显升高(P<0.01),组间比较,8周末帕利哌酮组BDNF浓度较奥氮平组明显升高,有统计学意义(P<0.01)。结论:帕利哌酮治疗精神分裂症的疗效与奥氮平相当,对糖代谢影响及升高血清BDNF的浓度优于奥氮平。

AIM： To explore the effect of paliperidone and olanzapine treating patients with firstepisode schizophrenia and their influence on sugar metabolism and serum levels of brain-derived neurotrophic factor（ BDNF）. METHODS： 80 patients with first-episode schizophrenia were randomly divided into paliperidone group（ n = 40） and olanzapine group（ n = 40） for an 8-week study. Positive and Negative Syndrome Scale（ PANSS） was used to assess clinical efficacy,at the same time the Treatment Emergent Symptom Scale（ TESS） was used to assess treatment of adverse reactions. Fasting blood sugar of the two groups at baseline,4th and 8th weekend were detected,and serum levels of BDNF were measured by enzyme-linked immuno sorbent assay（ ELISA）. RESULTS： The effective rate was similar（ 68. 4% vs. 63. 1%,P〉0. 05） after 8 weeks of treatment; In both groups,the factors and total scores of PANSS at the 4th,8th weekend were significantly lower than those at the baseline,the difference was statistically significant（ P〈0. 05）,yet positive and negative symptoms score had no statistical significant differences between two groups.Comparison between the groups,olanzapine group FBS levels at 8th weekend had increased significantly than the 4th weekend（ P〈0. 01）,and paliperidone group had no significant differences. Comparison between groups,FBS levels in olanzapine group were obviously higher than those of paliperidone groups at the 8th weekend,the difference was statistically significant（ P〈0. 01）. BDNF concentrations of two groups were significantly higher at 4th,8th weekend than those at the baseline（ P〈0. 01）.Comparison between groups,BDNF concentration in paliperidone group was obviously higher than that of olanzapine groups at the 8th weekend,the difference was statistically significant（ P〈0. 01）. CONCLUSION： Paliperidone and olanzapine have similar clinical efficacy in treating first-episode schizophrenia,paliperidone is better than olanzapine in regulating sugar metabolism index and elevated serum concentration of BDNF.