棕榈酸帕利哌酮与奥氮平治疗精神分裂症的疗效及对患者代谢影响的比较

Effect of paliperidone palmitate and olanzapine in the treatment of schizophrenia and its influence on the metabolism of patients

目的比较棕榈酸帕利哌酮与奥氮平治疗精神分裂症的疗效及对患者代谢的影响。方法选择台州市第二人民医院2017年2月至2019年2月收治的精神分裂症患者86例为研究对象,依据随机数字表法分为观察组43例、对照组43例。观察组于三角肌部位注射棕榈酸帕利哌酮,对照组口服奥氮平片。两组疗程均为12周。比较两组治疗前后阳性和阴性症状量表(PANSS)评分、临床疗效总评量表(CGI)评分、体质量、糖代谢、脂代谢和血清催乳素的变化。结果治疗前,两组PANSS评分、CGI评分、体质量、糖代谢、脂代谢和血清催乳素差异均无统计学意义(均P>0.05)。治疗后,对照组PANSS评分、CGI评分分别为(37.25±3.78)分、(2.51±0.36)分,观察组分别为(37.28±4.35)分、(2.63±0.43)分,两组均较治疗前降低(对照组:t=29.010、11.817,观察组:t=36.257、13.503,均P<0.05),组间差异均无统计学意义(均P>0.05);治疗后,对照组、观察组体质量分别为(68.27±4.35)kg、(62.18±3.56)kg,观察组低于对照组(t=7.105,P<0.05);治疗后,对照组空腹血糖(FPG)、糖化血红蛋白(HbA1c)分别为(5.91±0.27)mmol/L、(8.94±0.78)%,观察组分别为(5.39±0.34)mmol/L、(7.65±0.63)%,观察组均低于对照组(t=7.854、8.437,均P<0.05);对照组总胆固醇、低密度脂蛋白胆固醇、甘油三酯分别为(4.27±0.42)mmol/L、(3.27±0.43)mmol/L、(1.87±0.28)mmol/L,观察组分别为(3.54±0.48)mmol/L、(2.56±0.54)mmol/L、(1.35±0.36)mmol/L,两组差异均有统计学意义(t=7.505、6.745、7.477,均P<0.05);治疗后,对照组血清催乳素为(84.35±12.41)μg/L,观察组为(59.87±9.53)μg/L,观察组低于对照组(t=10.259,P<0.05)。结论棕榈酸帕利哌酮治疗精神分裂症患者疗效与奥氮平相当,但其对体质量、糖代谢、脂代谢和催乳素影响小。

Objective To compare the effects of paliperidone palmitate and olanzapine in the treatment of schizophrenia and its influence on the metabolism of patients.Methods From February 2017 to February 2019,86 patients with schizophrenia admitted to the Second People's Hospital of Taizhou were divided into observation group(43 cases)and control group(43 cases)according to random number table method.The observation group was injected paliperidone palmitate into deltoid muscle,while the control group was given olanzapine orally.Both two groups were treated for 12 weeks.The changes of PANSS and CGI scores,body mass,glucose metabolism,lipid metabolism and serum prolactin were compared between the two groups before and after treatment.Results Before treatment,there were no statistically significant differences in the PANSS score,CGI score,body mass,glucose metabolism,lipid metabolism and serum prolactin between the two groups(all P>0.05).After treatment,the PANSS score and CGI score in the control group were(37.25±3.78)points and(2.51±0.36)points,respectively,which in the observation group were(37.28±4.35)points and(2.63±0.43)points,respectively,which were lower than before treatment(control group:t=29.010 and 11.817,observation group:t=36.257 and 13.503,all P<0.05),there were no statistically significant differences between the two groups(all P>0.05).After treatment,the body weight of the observation group was(62.18±3.56)kg,which was lower than that of the control group[(68.27±4.35)kg](t=7.105,P<0.05).After treatment,the fasting blood glucose(FBG)and HbA1c of the control group were(5.91±0.27)mmol/L,(8.94±0.78)%,respectively,which were higher than those of the observation group[(5.39±0.34)mmol/L and(7.65±0.63)%](t=7.854,8.437,all P<0.05).The levels of TC,LDL-C and TG in the control group were(4.27±0.42)mmol/L,(3.27±0.43)mmol/L,(1.87±0.28)mmol/L,respectively,which in the observation group were(3.54±0.48)mmol/L,(2.56±0.54)mmol/L,(1.35±0.36)mmol/L,respectively,the differences were statistically significant between the two groups(t=7.505,6.745,7.477,all P<0.05).After treatment,the serum level of prolactin of the control group was(84.35±12.41)μg/L,which was higher than that of the observation group[(59.87±9.53)μg/L](t=10.259,P<0.05).Conclusion Paliperidone palmitate is as effective as olanzapine in the treatment of schizophrenia,but it has little effect on body weight,glucose metabolism,lipid metabolism and prolactin level.