加味逍遥散联合奥氮平对精神分裂症患者认知功能、内分泌激素和神经功能的影响

Study on the Effects of Jiawei Xiaoyao Decoction Combined with Olanzapine on Cognitive Function,Endocrine Hormone and Nerve Function Index in Schizophrenic Patients

目的:探讨加味逍遥散联合奥氮平对精神分裂症患者认知功能、内分泌激素和神经功能指标的影响。方法:选取2015年6月至2017年6月广州医科大学附属脑科医院收治的精神分裂症患者94例,按照随机数字表法随机分为观察组和对照组,每组47例。对照组采用奥氮平治疗,观察组在对照组基础上结合加味逍遥散治疗。2组疗程均为8周。比较2组治疗疗效,治疗前后阳性和阴性症状量表(PANSS)评分、认知功能评定量表(LOTCA)评分、内分泌激素水平和神经功能水平变化及不良反应发生情况。结果:观察组总有效率(91. 49%)高于对照组(70. 21%),且差异有统计学意义(P <0. 05)。2组治疗后PANSS评分降低而LOTCA评分增加(观察组:t=45. 555、18. 928,对照组:t=16. 472、11. 048,P <0. 05);观察组治疗后PANSS评分低于对照组而LOTCA评分高于对照组(t=18. 893、8. 331,P <0. 05)。2组治疗后睾酮(TEST)、游离三碘甲状腺原氨酸(FT3)和游离甲状腺素(FT4)水平降低(观察组:t=5. 987、6. 464、4. 352,对照组:t=12. 492、14. 307、7. 998,P <0. 05);观察组治疗后睾酮、FT3和FT4水平高于对照组(t=8. 939、12. 469、6. 014,P <0. 05)。2组治疗后血清脑源性神经营养因子(BDNF)水平升高而神经元特异性烯醇化酶(NSE)水平降低(观察组:t=9. 022、13. 400,对照组:t=5. 725、5. 626,P <0. 05);观察组治疗后血清BDNF水平高于对照组而NSE水平低于对照组(t=4. 089、9. 274,P <0. 05)。观察组不良反应发生率(8. 51%)低于对照组(29. 79%),且差异有统计学意义(P <0. 05)。结论:加味逍遥散联合奥氮平可改善精神分裂症患者认知功能,且不会造成严重内分泌激素和神经功能紊乱,不良反应小,用药安全性良好。

Objective To investigate the effects of Jiawei Xiaoyao Decoction combined with olanzapine on cognitive function,endocrine hormone and nerve function in patients with schizophrenia. Methods： A total of 94 schizophrenic patients admitted to our hospital from June 2015 to June 2017 were selected and divided into observation group（47 cases）and control group（47 cases）according to random number table method.The control group was treated with olanzapine,and the observation group was treated with Jiawei Xiaoyao Decoction on the basis of the control group.The 2 groups were treated for 8 weeks.The curative effects of the 2 groups were compared,and the changes of PANSS score,LOTCA score,endocrine hormone level and nerve function level before and after treatment,and the occurrence of adverse reactions were compared. Results： The total effective rate of the observation group（91.49%）was higher than that of the control group（70.21%）（ P 〈0.05）.The PANSS scores of the 2 groups decreased after treatment,while the LOTCA scores increased（observation group： t =45.555,18.928,control group： t =16.472,11.048, P 〈0.05）.After treatment,the PANSS score of the observation group was lower than that of the control group,while the LOTCA score was higher than that of the control group（ t =18.893,8.331, P 〈0.05）.After treatment,the levels of TEST,FT 3 and FT 4 decreased in 2 groups（observation group： t =5.987,6.464,4.352,control group： t =12.492,14.307,7.998, P 〈0.05）.After treatment,the levels of TEST,FT 3 and FT 4 in observation group were higher than that of control group（ t =8.939,12.469,6.014, P 〈0.05）.The serum BDNF levels of 2 groups were increased and NSE levels were decreased after treatment（observation group： t =9.022,13.400,control group： t =5.725,5.626, P 〈0.05）; after treatment,serum BDNF levels in observation group were higher than that of control group,and NSE levels were lower than control group（ t =4.089,9.274, P 〈0.05）.The incidence of adverse reaction in observation group（8.51%）was lower than that of control group（29.79%）（ P 〈0.05）. Conclusion： Jiawei Xiaoyao Decoction combined with olanzapine can improve the cognitive function of schizophrenic patients.It will not cause serious endocrine hormones and nerve function disorders.It has little adverse reaction,but with good safety.It is worth promotion and research.