氯氮平治疗老年中晚期帕金森病患者震颤、睡眠障碍及精神症状的疗效观察

Clozapine in the treatment of tremor,sleep disorder and mental symptoms in elderly patients with advanced Parkinson’s disease

目的探讨氯氮平对老年中晚期帕金森病患者震颤、睡眠障碍及精神症状的治疗作用。方法选取辽宁省金秋医院2016年6月至2019年7月收治的老年中晚期帕金森患者59例,随机分为对照组和治疗组,对照组29例,治疗组30例。对照组给予富马酸喹硫平治疗,治疗组给予氯氮平治疗。比较两组患者治疗前及治疗4周的新版世界运动障碍学会帕金森病综合评定量表第三部分(MDS-UPDRSⅢ)其中震颤部分评分、阳性与阴性症状评分(PANSS)、帕金森病睡眠评分(PDSS)、Epworth嗜睡评分(ESS)。结果两组治疗前MDS-UPDRSⅢ其中震颤部分评分、PANSS、PDSS、ESS没有统计学差异(P>0.05)。治疗4周后治疗组的UPDRSⅢ(震颤部分)评分低于治疗前,具有统计学差异(P<0.01),而对照组较治疗前无变化,没有统计学差异(P>0.05)。治疗4周后,两组的PANSS、ESS均低于治疗前,PDSS均高于治疗前,具有统计学差异(P<0.01)。治疗4周后,治疗组的PANSS与对照组对比没有统计学差异(P>0.05),治疗组的ESS、PDSS与对照组对比差异具有统计学意义(P<0.01)。结论对于老年中晚期帕金森患者,在控制震颤及改善睡眠障碍方面,氯氮平优于喹硫平;在改善精神症状方面,二者作用一致。低剂量氯氮平不良反应较少。

Objective To explore the therapeutic effect of clozapine on tremor,sleep disturbance and mental symptoms in elderly patients with advanced Parkinson’s disease.Methods Fifty-nine elderly patients with advanced Parkinson’s disease who were admitted to Liaoning Jinqiu Hospital from June 2016 to July 2019 were randomly divided into a control group and a treatment group,with 29 cases in the control group and 30 cases in the treatment group.The control group was given quetiapine and the treatment group was given clozapine.Before and after 4 weeks of treatment,the tremor part of the Movement Disorder Society-Sponsored Revision Unified Parkinson’s Disease Rating Score PartⅢ(MDS-UPDRSⅢ),the positive and negative symptom score(PANSS),the Parkinson’s disease sleep score(PDSS),Epworth sleepiness score(ESS)of the two groups were compared.Results There were no statistically significant differences in the tremor part of MDS-UPDRSⅢ,PANSS,PDSS and ESS of the two groups before treatment(P>0.05).After 4 weeks of treatment,the tremor part of the UPDRSⅢin the treatment group was lower than before treatment,with statistical difference(P<0.01),while the control group had no change compared with before treatment,and there was no statistical difference(P>0.05).After 4 weeks of treatment,the PANSS and ESS of both groups were lower than before treatment,and the PDSS was higher than before treatment,with statistical difference(P<0.01).After 4 weeks of treatment,there was no statistical difference in the PANSS score of the treatment group and the control group(P>0.05),and the ESS and PDSS of the treatment group were statistically significant compared with the control group(P<0.01).Conclusion For elderly patients with advanced Parkinson’s disease,clozapine is superior to quetiapine in controlling tremor and improving sleep disorders.The effect in improving mental symptoms is same in the two groups,while the low-dose clozapine is safer than the quetiapine.