阿立哌唑联合MECT治疗精神分裂症的疗效及对患者糖脂代谢、甲状腺功能及血清神经营养因子水平的影响

Efficacy of aripiprazole combined with MECT in the treatment of schizophrenia and its effect on glucose and lipidmetabolism, thyroid function, and serum neurotrophic factor levels

目的观察阿立哌唑联合无抽搐电休克疗法(MECT)治疗精神分裂症的疗效,并探讨其对患者糖脂代谢、甲状腺功能及血清神经营养因子水平的影响。方法回顾性分析2017年5月至2020年5月在安康市中心医院接受治疗的90例精神分裂症患者的临床资料,按照治疗方式不同分为观察组和对照组各45例。对照组患者给予奥氮平联合MECT治疗,观察组患者给予阿立哌唑联合MECT治疗,均持续治疗6周。比较两组患者治疗6周后的临床疗效,以及治疗前、治疗6周后的阳性和阴性精神症状评定量表(PANSS)评分、空腹血糖(FBG)、餐后2 h血糖(2 hPBG)、总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、总三碘甲腺原氨酸(T3)、总甲状腺素(T4)、游离三碘甲状腺原氨酸(FT4)、游离甲状腺素(FT4)、血清脑源性神经营养因子(BDNF)、神经生长因子(NFG)和神经营养因子(NT-3)水平,并比较治疗期间不良反应发生情况。结果治疗后,观察组和对照组患者的临床疗效总有效率分别为88.89%和84.44%,PANSS评分分别为(50.93±7.63)分和(52.11±6.80)分,差异均无统计学意义(P>0.05);治疗后,观察组患者的FBG、2 hPBG、TG水平分别为(5.28±0.60)mmol/L、(6.83±0.59)mmol/L、(1.16±0.22)mmol/L,明显低于对照组的(6.11±0.49)mmol/L、(7.91±0.81)mmol/L、(1.57±0.25)mmol/L,差异均有统计学意义(P<0.05);治疗后,观察组患者的T3、T4、FT3、FT4及血清BDNF、NGF、NT-3水平分别为(1.35±0.37)nmol/L、(116.02±20.51)nmol/L、(4.95±0.68)pmol/L、(13.02±2.84)pmol/L、(11.93±2.04)μg/L、(43.50±3.82)pg/mL、(171.03±18.69)pg/mL,明显高于对照组的(1.16±0.20)nmol/L、(98.84±12.16)nmol/L、(4.17±0.61)pmol/L、(11.13±1.56)pmol/L、(9.20±1.75)μg/L、(36.76±3.41)pg/mL、(148.74±20.11)pg/mL,差异均有统计学意义(P<0.05);观察组和对照组患者的不良反应总发生率分别为35.56%和37.78%,差异无统计学意义(P>0.05)。结论与奥氮平联合MECT比较,阿立哌唑联合MECT对精神分裂症患者糖脂代谢、甲状腺功能的影响更小,且可有效改善血清神经营养因子水平,值得临床推广应用。

Objective To observe the efficacy of aripiprazole combined with modified electroconvulsive therapy(MECT)in the treatment of schizophrenia,and to explore its effect on patients with glucose and lipid metabolism,thyroid function and serum neurotrophic factor levels.Methods The clinical data of 90 patients with schizophrenia were retrospectively analyzed,who were treated in Ankang Central Hospital from May 2017 to May 2020.According to different treatment methods,they were divided into observation group and control group with 45 cases in each group.The control group was treated with olanzapine combined with MECT,and the observation group was treated with aripiprazole combined with MECT,both for 6 weeks.The clinical efficacy of the two groups after 6 weeks of treatment was compared,as well as the Positive and Negative Syndrome Scale(PANSS)scores and the levels of fasting blood glucose(FBG),2 h postprandial blood glucose(2 hPBG),total cholesterol(TC),triglyceride(TG),low density lipoprotein cholesterol(LDL-C),high density lipoprotein cholesterol(HDL-C),total triiodothyronine(T3),total thyroxine(T4),free triiodothyronine(FT4),free thyroxine(FT4),serum brain-derived neurotrophic factor(BDNF),nerve growth factor(NFG),and neurotrophic factor(NT-3)before and after 6 weeks of treatment.The incidence of adverse reactions during treatment was also compared.Results After treatment,the total clinical effective rates were 88.89%in the observation group and 84.44%in the control group,and the PANSS score was respectively(50.93±7.63)points and(52.11±6.80)points;both differences were not statistically significant(P>0.05).After treatment,the levels of FBG,2 hPBG and TG in the observation group were respectively(5.28±0.60)mmol/L,(6.83±0.59)mmol/L,and(1.16±0.22)mmol/L,which were significantly lower than corresponding(6.11±0.49)mmol/L,(7.91±0.81)mmol/L,and(1.57±0.25)mmol/L in the control group(P<0.05).After treatment,the levels of T3,T4,FT3,FT4,serum BDNF,NGF,and NT-3 were significantly higher in the observation group than in the control group,i.e.T3(1.35±0.37)nmol/L vs(1.16±0.20)nmol/L,P<0.05;T4(116.02±20.51)nmol/L vs(98.84±12.16)nmol/L,P<0.05;FT3(4.95±0.68)pmol/L vs(4.17±0.61)pmol/L,P<0.05;FT4(13.02±2.84)pmol/L vs(11.13±1.56)pmol/L,P<0.05;BDNF(11.93±2.04)μg/L vs(9.20±1.75)μg/L,P<0.05;NGF(43.50±3.82)pg/mL vs(36.76±3.41)pg/mL,P<0.05;and NT-3(171.03±18.69)pg/mL vs(148.74±20.11)pg/mL,P<0.05.The total incidence of adverse reactions was 35.56%in the observation group and 37.78%in the control group,and the difference was not statistically significant(P>0.05).Conclusion Compared with olanzapine combined with MECT,aripiprazole combined with MECT has a smaller effect on glucose and lipid metabolism and thyroid function in patients with schizophrenia,and it can effectively improve the serum levels of neurotrophic factor,which is worthy of clinical application.