奥氮平与利培酮治疗老年脑器质性精神障碍的临床观察

Clinical Observation on Olanzapine and Risperidone in Treatment of Elderly Patients with Senile Brain Organic Mental Disorder

目的探讨奥氮平与利培酮治疗老年脑器质性精神障碍的临床疗效和安全性。方法将80例老年脑器质性精神障碍患者随机分为奥氮平组和利培酮组各40例。在原发病常规治疗基础上,奥氮平组给予奥氮平片口服,利培酮组则给予利培酮片口服,两组达到维持剂量后持续进行维持治疗至少48周以上。比较治疗前后两组患者阳性与阴性症状量表改善情况,统计治疗期间不良反应发生率,以及体质量、空腹血糖、糖化血红蛋白、甘油三酯、总胆固醇、高密度脂蛋白胆固醇和低密度脂蛋白胆固醇水平的变化。结果两组治疗后PANSS评分均较治疗前显著下降(P <0. 01),但两组之间比较,差异无统计学意义(P> 0. 05)。奥氮平组嗜睡发生率显著高于利培酮组(P <0. 01),但失眠发生率低于利培酮组(P <0. 05)。奥氮平组治疗48周后体质量、FPG和Hb A1c水平均显著高于利培酮组(P <0. 05,P <0. 01)。结论奥氮平与利培酮治疗老年脑器质性精神障碍的临床疗效相似,但奥氮平的嗜睡发生率较高,利培酮的失眠发生率较高,且奥氮平对体质量和血糖指标的影响更为显著。

Ojbective To compare the clinical efficacy and safety of olanzapine and risperidone in the treatment of elderly patients with senile brain organic mental disorder.Methods A total of80 elderly patients with senile organic mental disorder were randomly divided into the olanzapine group and risperidone group with 40 cases in each.On the basis of routine treatment of primary disease,the patients in the olanzapine group were treated with oral olanzapine tablets while the patients in the risperidone group received oral risperidone tablets.The patients in the two groups were continually treated for at least 48 weeks after reaching the maintenance dose.The improvement of positive and negative symptom scales(PANSS)was compared between the two groups before and after treatment.The changes in the incidence of adverse reactions,body mass,fasting blood glucose(FPG),glycosylated hemoglobin(HbA1c),triglyceride(TG),total cholesterol(TC),high-density lipoprotein cholesterol(HDL-C)and low-density lipid(LDL-C)were counted during the treatment.Results The PANSS scores of the two groups were significantly lower than those before treatment(P<0.01),but there was no significant difference between the two groups(P>0.05).The incidence of somnolence in the olanzapine group was significantly higher than that in risperidone group(P<0.01),but the incidence of insomnia was lower than that in the risperidone group(P<0.05).The body mass,FPG and HbA1c levels in the olanzapine group were significantly higher than those in the risperidone group 48 weeks after treatment(P<0.05,P<0.01).Conclusion The clinical efficacy of olanzapine and risperidone in the treatment of elderly patients with senile organic mental disorders is similar,but olanzapine has a higher incidence of somnolence and risperidone has a higher incidence of insomnia.But the treatment with olanzapine has a more significant effect on body mass and blood glucose.