丙戊酸钠分别与齐拉西酮和奥氮平联用治疗Ⅰ型双相情感障碍临床对比研究

Clinical comparative study of sodium valproate separately combined with ziprasidone and olanzapine in the treatment of bipolar disorder type I

目的探讨丙戊酸钠分别与齐拉西酮和奥氮平联用治疗Ⅰ型双相情感障碍临床疗效差异。方法选取Ⅰ型双相情感障碍患者共100例，采用随机数字表法分为A组（50例）和B组（50例），在丙戊酸钠基础上分别联合奥氮平和齐拉西酮辅助治疗；比较两组近期疗效，治疗前后贝克躁狂量表（BRMS）评分、数字符号评分、连线测验A／B（TMT）评分、威斯康星片分类测验（WCST）评分及汉诺塔认知功能评分（TOH）。结果A组和B组临床治疗总有效率分别为88．00％和92．00％，两组差异无统计学意义（χ^2=8．14，P〉0．05）；两组治疗后BRMS评分均显著低于治疗前（t=3．74、4．06，均P〈0．05）；两组治疗后BRMS评分组间差异无统计学意义（t=0．89，P〉0．05）；B组治疗后数字符号评分、WCST评分及TOH认知功能评分均显著高于A组、治疗前（t=3．17、4．03、3．96、3．54、2．86、3．81、4．66、4．29、3．81、3．43，均P〈0．05）；B组治疗后TMTA／B评分均显著低于A组、治疗前（t=3．82、4．82、4．55、4．09、3．83，均P〈0．05）。结论丙戊酸钠分别与齐拉西酮和奥氮平联用治疗Ⅰ型双相情感障碍在缓解躁狂症状方面效果接近，但丙戊酸钠联合齐拉西酮方案更有助于促进认知功能损伤恢复，改善远期预后。

Objective To compare the clinical effects of sodium valproate separately combined with ziprasidone and olanzapine in the treatment of bipolar disorder type I. Methods 100 patients with bipolar disorder type I were chosen. According to the digital table, the patients were randomly divided into two groups, including A group （50 children） with olanzapine and B group （50 children） with ziprasidone on the basis of sodium valproate. The clinical effects, the BRMS score, digit symbol scores, TMT A/B scores, WCST score and TOH cognitive function scores before and after treatment of the two groups were compared. Results The total effective rates of A group and B group were 88.00% ,92.00%, respectively. There was no statistically significant difference in clinical effects between the two groups（ χ^2 = 8.14 ,P 〈 0.05 ）. The BRMS scores of both two groups after treatment were significantly lower than before treatment（ t = 3,74,4.06, all P 〈 0.05 ）. There was no statistically significant difference in BRMS score after treatment between the two groups （ t = 0. 89, P 〉 0.05 ）. The digit symbol scores, WCST score and TOH cognitive function scores of B group after treatment were significantly higher than those of A group and before treatment （ t = 3.17,4.03,3.96,3.54,2.86,3.81,4.66,4.29,3.81,3.43, all P 〈 0.05 ）. The TMT A/B scores of B group after treatment were significantly lower than those of A group and before treatment （ t = 3.82,4.82,4.55,4.09,3.83, all P 〈 0.05）. Conclusion Sodium valproate separately combined with ziprasidone and olanzapine in the treatment of bipolar disorder type I possess the same clinical effects in manic symptoms relief, and sodium valproate combined with ziprasidone can effectively promote the recovery process of cognitive function damage and improve the clinical prognosis for long - term.