氯氮平联合阿立哌唑治疗精神分裂症阳性症状患者的疗效及对认知功能的影响分析

Efficacy of clozapine combined with aripiprazole in the treatment of patients with positive symptoms of schizophrenia and its influence on cognitive function

目的分析氯氮平联合阿立哌唑治疗精神分裂症阳性症状患者的疗效及对认知功能的影响。方法收集2018年10月至2021年12月本院收治的240例精神分裂症阳性症状患者,根据电脑数字表法随机进行分组。对照组120例予以氯氮平治疗,观察组120例在对照组的基础上联合阿立哌唑进行治疗,基线及6周后,采用临床总体印象量表第2项(CGI-SI)、阳性与阴性症状量表(PANSS)表中的阳性症状维度评定患者疾病症状,采用脑电图仪评分患者脑电图活动情况,威斯康星卡片分类测验(WCST)、数字广度测试(DS)对患者认知功能进行评定,并比较其临床疗效。结果治疗6周后,2组患者的CGI-SI、PANSS表中的阳性症状评分均较治疗前降低(t对照组=28.16、10.72,t观察组=35.69、18.39,P均<0.05),且治疗后观察组评分低于对照组(t=7.70、8.60,P均<0.05)。治疗后2组的脑电图活动的异常率较治疗前有所升高,但比较差异无统计学意义(χ^(2)_(对照组)=2.46,P=0.117,χ^(2)_(观察组)=1.02,P=0.31),且2组治疗后脑电图活动的异常率进行组间比较,差异无统计学意义(χ^(2)=0.17,P=0.68)。治疗后,2组患者WCST测验中的完成分类次数较治疗前升高(t对照组=7.97,t观察组=11.18,P均<0.05),且观察组高于对照组(t=3.15,P=0.002),而2组的持续错误与随机错误次数则明显降低(t对照组=4.48、11.67,t观察组=9.35、20.19,P均<0.05),且观察组低于对照组(t=5.44、8.94,P均<0.05)。同时,2组患者的DS评分均较治疗前升高(t对照组=13.42,t观察组=21.26,P均<0.05),且观察组更高(t=7.52,P<0.05)。观察组的总有效率是95.0%,高于对照组的87.5%(χ^(2)=4.23,P=0.040)。结论氯氮平联合阿立哌唑治疗精神分裂症阳性症状患者的疗效显著,能够提升患者的治疗效果,改善疾病症状,对脑电图活动的影响较小,并且能促进患者认知功能恢复。

Objective To analyze the efficacy of clozapine combined with aripiprazole in the treatment of patients with positive symptoms of schizophrenia and its influence on cognitive function.Methods Two hundred and forty cases with positive symptoms of schizophrenia admitted to our hospital from October 2018 to December 2021 were collected,and randomly divided into two groups according to the computer digital table method.120 cases in the control group were treated with clozapine,and 120 cases in the observation group were treated with aripiprazole on the basis of the control group.At baseline and after 6 weeks,the disease symptoms of the patients were evaluated by the second item of the clinical global impression scale(CGI-SI)and the positive and negative syndrome scale(PANSS)table,and the electroencephalogram(EEG)was scored by the electroencephalo-graph.Figure activity,Wisconsin card sorting test(WCST)and digital span test(DS)were used to evaluate the cognitive function of patients,and their clinical efficacy was compared.Results After 6 weeks of treatment,the positive symptom scores in the CGI-SI and PANSS table of the two groups of patients were lower than those before treatment(t_(control)group=28.16,10.72,t_(observation)group=35.69,18.39,both P<0.05).The scores in the observation group were lower than those in the control group(t=7.70,8.60,both P<0.05).After treatment,the abnormal rate of EEG activity in the two groups was higher than that before treatment,but the difference was not statistically significant(χ_(control group)^(2)=2.46,P=0.117,χ_(observation group)^(2)=1.02,P=0.314),and the abnormal rate of EEG activity between the two groups after treatment were compared,and the difference was also not statistically significant(χ^(2)=0.17,P=0.68).After treatment,the number of completed classifications in the WCST test of the two groups was higher than that before treatment(tcontrol group=7.97,tobservation group=11.18,both P<0.05),and the observation group was higher than the control group(t=3.15,P=0.002),while the number of continuous errors and random errors in the two groups was significantly reduced(t_(control group)=4.48,11.67,t_(observation group)=9.35,20.19,both P<0.05),and the observation group was lower than the control group(t=5.44,8.94,P<0.05).At the same time,the DS scores of the two groups were higher than those before treatment(t_(control group)=13.42,tobservation group=21.26,both P<0.05),and the observation group was higher(t=7.52,P<0.05).The total effective rate in the observation group was 95.0%,which was higher than 87.5%in the control group(χ^(2)=4.23,P=0.040).Conclusion Clozapine combined with aripiprazole has a significant curative effect in the treatment of patients with positive symptoms of schizophrenia and can improve both the patients′treatment effect and improve the disease symptoms.It has less impact on EEG activity and can promote the recovery of patients′cognitive function.