氯氮平与齐拉西酮对老年痴呆精神行为障碍患者认知及脂代谢的影响

Effect of clozapine and ziprasidone on cognitive function and lipid metabolism of senile dementia complicated with psychiatric and behavioral disorders

目的对比分析氯氮平与齐拉西酮对老年痴呆精神行为障碍患者认知及脂代谢的影响。方法选取2014年2月至2016年9月我院收治的老年痴呆精神行为障碍患者108例,根据治疗方式的不同将其分为氯氮平组与齐拉西酮组,每组54例,两组均连续治疗8周。评估并比较两组临床疗效,采用简易智能精神状态检查量表(MMSE)和蒙特利尔认知功能量表(MoCA)评价并比较两组患者治疗前后认知能力变化,检测并比较两组患者治疗前后血脂代谢指标的变化;采用药物不良反应量表(TESS)比较两组患者治疗期间不良反应发生情况。结果治疗后,齐拉西酮组有效率(94.44%)显著高于氯氮平组(77.78%)(P<0.05);两组患者MMSE评分与MoCA评分与治疗前相比均升高(P<0.01),且齐拉西酮组高于氯氮平组(P<0.01);齐拉西酮组患者血清TC、TG、LDL、HDL水平及BMI与治疗前比较差异无统计学意义(P>0.05),氯氮平组患者血清TC、TG、LDL水平及BMI高于治疗前及齐拉西酮组(P<0.05或P<0.01),HDL水平较治疗前降低,且低于齐拉西酮组(P<0.05或P<0.01);齐拉西酮组患者TESS评分为(3.62±1.25)分,低于氯氮平组的(5.85±2.31)分(P<0.01)。结论齐拉西酮治疗老年痴呆精神行为障碍的疗效优于氯氮平,同时可显著增强患者认知能力,对脂代谢的影响较小且不良反应较少。

Objective To compare the effect of clozapine and ziprasidone on cognitive function and lipid metabolism of senile dementia complicated with psychiatric and behavioral disorders.Methods Totally 108 cases of patients with senile dementia complicated with psychiatric and behavioral disorders admitted to our hospital from February 2014 to September 2016 were selected and divided into clozapine group and ziprasidone group based on the difference of treatment,54 cases in each group,the two groups were treated consecutively for 8 weeks.The efficacy of the two groups was assessed and compared before and after treatment;Mini Mental State Examination(MMSE)and Montreal Cognitive Assessment(MoCA)were used to assess and compare the change of cognitive function in the two groups;the metabolism of blood lipid of the two groups was detected and compared before and after treatment;the adverse reactions in the two groups were compared with Treatment Emergent Symptom Scale(TESS).Results After treatment,the efficiency of ziprasidone group(94.44%)was significantly higher than that of clozapine group(77.78%)(P<0.05);the MMSE score and MoCA score in both groups increased compared with those before treatment(P<0.01),and ziprasidone group was higher than clozapine group(P<0.01);there was no significant difference in serum TC,TG,LDL,HDL levels or BMI in ziprasidone group compared with before treatment(P>0.05);the levels of TC,TG,LDL and BMI in clozapine group were higher than those before treatment and those of ziprasidone group(P<0.05 or P<0.01),but the HDL level was lower than that before treatment and that of ziprasidone group(P<0.05 or P<0.01);the TESS score of ziprasidone group was(3.62±1.25),which was lower than that of clozapine group(5.85±2.31)(P<0.01).Conclusion Ziprasidone is superior to clozapine in the treatment of mental and behavioral disorders in senile dementia,and it can significantly enhance the cognition ability of patients,with less effect on lipid metabolism and less adverse reactions.