度洛西汀短期治疗精神分裂症的增效作用及对认知损害变化的影响

Synergetic effect of short-term prescription of duloxetine on schizophrenic patients and its impact on cognition disorders

目的探讨度洛西汀对阴性症状为主的精神分裂症患者临床疗效的增效作用、安全性和对认知损害的影响。方法将40例以阴性症状为主的精神分裂症患者随机分为研究组(氯氮平联合度洛西汀治疗)和对照组(单用氯氮平治疗)各20例,疗程8周,采用阳性和阴性症状量表(PANSS)评定疗效变化,采用Stroop色词测验(SCWT)、连线测验(TMT)A和B、词语和语义流畅性、威期康星卡片分类测验(WCST)评价认知功能变化,治疗中需处理的不良反应采用副反应量表(TESS)评定其安全性。结果经重复测量方差分析,两组的PANSS量表中阳性因子分、阴性因子分和总分的时间主效应,分组主效应,时间与分组交互效应差异均有显著意义(P<0.05或P<0.01)。两组间不良反应发生率及TESS评分均无显著差异(P>0.05)。治疗8周后,两组SCWT(Z=-3.468,P=0.001)和TMT-B(Z=-2.083,P=0.037)与治疗前相比具有显著差异;研究组语义流畅性测试优于对照组(Z=-2.137,P=0.033),其余各认知量表评分的组间无显著差异(P>0.05)。结论度洛西汀合并氯氮平治疗阴性症状为主的精神分裂症患者的疗效优于单用氯氮平,在短期内能起到一定增效作用,对认知损害症状有部分改善作用。

ATM To explore the synergetic effects, security and cognition disorders of short- term prescription duloxetine on the treatment of schizophrenia with predominantly negative symptoms. METHODS Totally 40 chronic schizophrenic patients with predominantly negative symptoms were randomly divided into study group and control group with 20 patients for each. The former were treated with duloxetine in combination with clozapine for the duration of 8 weeks, while the latter with clozapine for the same continuation. Treatment efficacy was assessed by positive and negative syndrome scale （PANSS）. Stroop colored word test （SCWT） , trail making test part （TMT） A and B, words and semantic fluency and Wisconsion card sorting test （WCST） were applied to evaluate the cognition function variations. In addition, TESS was used to appraise the adverse reactions. RESULTS The variance analysis showed that the time main effect, grouping main effect and time- grouping interactive effect in the PANSS scores of both the study group and the control group had statistical significances （P 〈 0.05 or P 〈 0.01）. The rates of adverse reactions and TESS scores had no significant differences between the two groups. In comparison with the baseline, scores of SCWT （Z = -3.468, P = 0.001） and TMT- B （Z = -2.083, P = 0.037） at the end of the treatment in both groups increased significantly. Moreover, the semantic fluency effect （Z = -2.137, P= 0.033） of the study group were better than that of the control group. There were no significant differences in the other cognitive functioning among the two groups （P 〉 0.05）. CONCLUSION The efficacy of the duloxetine-clozapine combined therapy, due to its synergetic effect and favorable impact on the schizophrenic patients＇ cognitive disorders, is better than that of the single prescription of clozapine.