血药浓度监测在精神分裂症患者的应用研究

Application of Blood Drug Concentration Monitoring in Schizophrenia Patients

目的探讨帕利哌酮在治疗急性精神分裂症患者血药浓度量效关系以及疗效和安全性。方法选取2017年7月至2019年6月90例精神分裂症患者,根据简单随机法分对照组予以利培酮治疗,观察组予以帕利哌酮治疗,最终有效例数为76例,对照组40例,观察组36例。比较两组患者治疗有效率及预后,并分析治疗后帕利哌酮血药浓度变化,及其与服药剂量、PANSS减分率、治疗时出现的症状量表(TESS)评分的相关性。结果观察组患者治疗有效率高于对照组(P<0.05)。治疗后2周、4周帕利哌酮血药浓度高于治疗后1周(P<0.05);治疗后2周、4周帕利哌酮血药浓度比较,差异无统计学意义(P>0.05)。Spearman相关性分析,发现治疗各时段帕利哌酮服药剂量与血药浓度呈正相关(P<0.05)。Spearman相关性分析,发现治疗各时段PANSS减分率、TESS评分与血药浓度无明显相关性(P>0.05)。采用重复测量设计的方差分析比较不同治疗效果患者各阶段血药浓度差异,两组间差异比较无统计学意义(F=0.354,P>0.05)。出现EPS组与未出现EPS组患者之间各时段帕利哌酮血药浓度比较无统计学差异(P>0.05)。观察组患者复发率低于对照组患者,个人和社会功能量表(PSP)评分高于对照组(P<0.05)。结论帕利哌酮治疗急性精神分裂症患者效果显著,预后较好,其血药浓度与服药剂量呈非线性正相关。

Objective To explore the dose-response relationship of paliperidone to treat acute schizophrenia,its efficacy and safety.Methods From July 2017 to June 2019,90 patients with schizophrenia were selected as subjects.According to simple random method,control group was treated with risperidone,and observation group was treated with paliperidone.Final effective number was 76 cases,including 40 cases in control group,36 cases in observation group.Treatment efficiency and prognosis were compared.The changes of paliperidone blood concentration after treatment,dosage,PANSS reduction rate and TESS score during treatment were analyzed.Results The effective rate of treatment in observation group was higher than that in control group(P<0.05).The blood concentration of paliperidone at 2 and 4 weeks after treatment was higher than that at 1 week after treatment(P<0.05).There was no significant difference in the blood concentration of paliperidone at 2 and 4 weeks after treatment(P>0.05).Spearman correlation analysis found that the dose of paliperidone at each treatment period was positively correlated with the blood concentration(P<0.05),and there was no significant correlation on PANSS score reduction rate,TESS score and blood drug concentration in each period of treatment(P>0.05).The variance analysis with repeated measures design was used to compare the difference in blood drug concentration in different treatment effects at each stage with no statistically significant difference(F=0.354,P>0.05).At each time period,there was no statistically significant difference in paliperidone blood concentration between EPS patients and no-EPS patients(P>0.05).The recurrence rate of observation group was lower than that of control group,the personal and social function scale(PSP)score was higher than that of control group(P<0.05).Conclusion Paliperidone has a significant effect to treat acute schizophrenia with good prognosis that its blood concentration is positively non-linear with dosage.