喹硫平替换氯氮平治疗精神分裂症临床疗效观察

Curative effect of clozapine replacement by quetiapine for the treatment of schizophrenia

目的探讨分析喹硫平替换氯氮平治疗精神分裂症临床疗效及对患者血清胰岛素、泌乳素与生活质量的影响。方法选取我院在2017年5~11月期间收治的120例经氯氮平治疗出现代谢异常的精神分裂症患者为研究对象,按照随机数字表法分为观察组(n=60)与对照组(n=60)。对照组患者给予单一的氯氮平治疗,治疗后首日将氯氮平日量减少1/4~1/3,此后每周氯氮平日量减1/2,治疗3个月;观察组患者在替换用喹硫平片0.2~0.4 g,分2次服用,一般每隔3 d调整剂量1次,4周加至0.6 g,最大日量不超过1.2 g,疗程为3个月。采用临床总体印象量表(CGI)病情严重程度(SI)进行评分和生活质量量表(SF-12),包括锥体外系副反应量表(RSESE)评定临床疗效,对比分析两组患者血清胰岛素及血糖与泌乳素的变化情况。结果从第2周开始,观察组CGI-SI评分与基线比较,差异有统计学意义(P<0.05),第6周末与第2周末比较,第12周末与第6周末比较,差异均有统计学意义(P<0.05),而对照组各时间段无明显变化(P>0.05);随着治疗时间越长,观察组社会功能改善越明显(P<0.05),而对照组各时间段无明显变化(P>0.05);两组血清胰岛素、血糖及泌乳素第12周末与基线时比较差异有统计学意义(P<0.05),且观察组血清胰岛素从第2周末开始升高比对照组快,血糖从第2周末开始降低比对照组快,泌乳素从第6周末开始与对照组有差异(P<0.05);治疗后,两组患者失眠、焦虑激越比较差异无统计学意义(P>0.05),头痛、头晕、便秘、肝功能异常差异均有统计学意义(P<0.05)。结论对氯氮平治疗出现代谢异常的精神分裂症患者,运用喹硫平替换治疗能改善患者的精神病性症状,且提高了社会功能,更具有安全性,值得推广。

Objective To investigate the clinical efficacy of clozapine replacement by quetiapine for the treatment of schizophrenia and its effect on serum insulin, prolactin and quality of life. Methods A total of 120 schizophrenic pa- tients with metabolic abnormalities treated by clozapine admitted in our hospital from May to November 2017 were se- lected and divided into two groups including observation group（n=60） and control group（n=60）, according to random num- ber table. Patients in the control group were given single clozapine treatment. The daily amount of clozapine was re- duced by 1/4-1/3 on the first day after treatment, and the daily amount of clozapine every week was reduced by 1/2. The treatment course was 3 months. The patients in the observation group were replaced with quetiapine tablets 0.2-0.4 g, administrated by two times. Usually the dose was adjusted 1 time every 3 d, adding to 0.6 g at the ：4th week. The maximum daily dose was not more than 1.2 g, and the course of treatment was 3 months. The score was assessed using the clinical gross impression scale（CGI） and the severity of illness（SI）. The clinical efficacy was assessed by quality of life scale （SF-12） including rating scale for extrapyramidal side effects. The changes of serum insulin and blood sugar and prolactin between the two groups were compared and analyzed. Results From the second week, there was statisti- cally significant difference between the CGI-SI score of the observation group and the baseline（P〈O.O5）.There was sig- nificant difference in the score of CGI-Si between the end of.the 6th week and 2th week, between the end of the 12th week and 6th week was statistically significant （P〈0.05）I While the contro! group had no significant change in the store of CGI-SI in each time period（P〉0.05）. With the longer treatment time, the improvement of social function in observation group was more obvious（P〈0.05）. While the control group had no significant change in the improvement of social i function in each time period（P〉0.05）.The levels of serum insulinl blood glucose and prolactin at the end of 12th week- end in the two groups were significantly different from the baseline （P〈0.05）. And the increase of serum insulin in observation group from the second weekend was faster than that in the control group. The decrease of blood sugar in observation group was faster from the second weekend than that of the control group. There was a significant difference inprolactin between the observation group and the control group from the beginning of the sixth weekend （P〈0.05）. After treatment, there were no significant differences in insomnia, anxiety and agitation between two groups （P〉0.05）. And there were significant differences in the headache, dizziness, constipation, liver dysfunction between two groups（P〈0.05）. Conclusion For schizophrenic patients with metabolic abnormalities treated by clozapine, the use of quetiapine replacement therapy can improve their psychotic symptoms and improve their social function, which is more safe and worthy of promotion.