阿立哌唑对男性精神分裂症患者继发药源性性功能障碍的影响

Aripiprazole for drug-induced sexual dysfunction in schizophrenic males

目的:探讨阿立哌唑治疗氨磺必利或利培酮致男性精神分裂症患者性功能障碍的临床疗效。方法:2014年10月至2016年10月收治的75例经氨磺必利或利培酮治疗后继发性功能障碍的首发精神分裂症患者为研究对象,采用交叉换药法2周内停服氨磺必利或利培酮,并逐渐增加阿立哌唑口服剂量至20~30 mg/d,第3周开始30 mg/d维持,记录阿立哌唑换药前、治疗4、8周后患者者性功能、催乳素(PRL)、睾酮(T)、阳性和阴性症状量表评分(PANSS)变化及药物不良反应。结果:75例患者改服阿立哌唑4周,患者性功能总评分[(32.6±3.6)分vs(24.3±2.1)分]、T[(17.4±3.0))mmol/L vs(13.3±2.7)mmol/L]均较换药前明显上升(P均<0.05),PRL[(27.9±8.2)ng/ml vs(38.5±10.5)ng/ml]显著下降(P<0.05);治疗8周,患者性欲评分、T、PRL均已恢复至入院时基线水平,性功能评分中勃起评分、射精评分、性满意度评分、总评分及T数值已超过基线水平,但差异均无统计学意义(P>0.05)。改服阿立哌唑4周后,患者PANSS评分均较换药前显著下降[(57.2±5.5)分vs(62.1±4.9)分,P<0.05];治疗8周后PANSS评分显著低于治疗4周后评分[(51.2±5.2)分vs(57.2±5.5)分,P<0.05]。改服阿立哌唑后,兴奋、头晕、失眠、食欲减退的发生率分别为6.7%、5.3%、4.0%、1.3%,未见其他严重不良发应。结论:阿立哌唑治疗男性精神分裂症合并药源性性功能障碍,能在继续改善阳性与阴性症状的同时,改善患者性功能,恢复生殖激素水平。

Objective： To investigate the clinical effects of aripiprazole on sexual dysfunction induced by amisulpride or risperi- done in male patients with schizophrenia. Methods： This study included 75 male patients with drug-induced secondary sexual dys- function after treated with amisulpride or risperidone for first-episode schizophrenia between October 2014 and October 2016. We sub- stituted aripiprazole for amisulpride or risperidone, gradually increased the dose from 10 to 30 mg/d within 2 weeks, and maintained 30 mg/d from the 3rd week. At 4 and 8 weeks after medication, we evaluated the sexual function of the patients, measured the levels of serum prolactin （PRL） and testosterone （T）, obtained the scores of the Positive and Negative Symptoms Scale （PANSS） , recorded adverse reactions, and compared the parameters with those before aripiprazole administration. Results： Compared with pre-aripi- prazole administration, the patients showed significant increases after 4 weeks of medication in the sexual function score （24.3 ±2.1 vs32.6 ± 3.6, P 〈0.05） andTlevel（[13.3 ± 2.7] vs [17.4±3.0] mmo]/L,P 〈0.05） butadecreasedlevelofPRL（[38.5 ± 10.5 ] vs [27.9 ± 8.2] ng/ml, P 〈 0.05）. At 8 weeks, the sexual function score and serum PRL were both restored to the base-line levels at admission, and the erectile function score, ejaculation score, total score, and serum T level even exceeded the baseline, though with no statistically significant differences （P 〉 0.05）. In comparison with pre-aripiprazole administration, the PANSS score was significantly decreased at 4 weeks after medication （62.1 ±4.9 vs 57.2 ± 5.5, P 〈0.05） and even lower at 8 weeks （51.2 ± 5.2） （P 〈 0.05）. The incidence rates of medication-related excitation, dizziness, insomnia, and loss of appetite were 6.7%, 5.3%, 4.0% and 1.3% respectively, and no other serious adverse reactions were observed. Conclusion： Aripiprazole is effective for the treatment of drug-induced sexual dysfunction in schizophrenic men by continuously alleviating their positive and negative symp- toms and meanwhile improving their sexual function and restoring their sexual hormone levels.