不同剂量奥氮平对首发精神分裂症患者维持期治疗的影响

Effects of different doses of olanzapine on patients with first-episode schizophrenia in maintenance phase

目的:探讨不同剂量奥氮平对首发精神分裂症患者维持期治疗的影响,为首发精神分裂症维持期服药剂量提供参考。方法:将2016年7月至2018年12月嘉兴市康慈医院、桐乡市第一人民医院200例使用奥氮平系统治疗进入维持期阶段的首发精神分裂症患者随机分为维持组及减量组,每组各100例。采用阳性和阴性症状量表(PANSS)、社会功能缺陷筛选量表(SDSS)及治疗中出现的不良反应量表(TESS)在基线、3个月、6个月、12个月、18个月、24个月各时点分别评定患者的精神症状、社会功能及药物不良反应。结果:随访至2年末,两组复发率比较差异无统计学意义。两组PANSS阴性症状评分、PANSS总分、SDSS评分、TESS评分的组别主效应、时间主效应及两者的交互效应均有统计学意义(P均<0.05)。维持组的阴性症状评分、PANSS总分及SDSS评分在18个月、24个月两个时点比较均高于减量组,差异有统计学意义(P均<0.05)。结论:首发精神分裂症患者维持治疗期继续使用奥氮平时,逐渐缓慢减少药物剂量至有效低剂量,不会增加患者的复发风险,且有利于减轻其阴性症状和药物不良反应,改善患者的社会功能。

Objective:To explore effects of different doses of olanzapine on patients with first-episode schizophrenia in maintenance phase.Method:200 patients with first-episode schizophrenia in maintenance phase who were administered in Kangci Hospital of Jiaxing and the first People's Hospital of Tongxiang from July 2016 to December 2018 with olanzapine treatment were randomly divided into the maintenance group and the decrement group,with 100 cases in each group.The positive and negative syndrome scale(PANSS),social disability screening schedule(SDSS),and treatment emergent symptom scale(TESS)were assessed at baseline and every six months thereafter to evaluate patients’psychiatric symptoms,social function,and adverse reactions.Results:The recurrence rates between the two group showed no statistical difference during the two years.There were significant group effect,time effect and group×time inferaction effect on PANSS,SDSS and TESS.The scores of PANSS(total score and nagetive symptom)and SDSS of patients in decrement group were significantly lower than those in maintenance group at the 18th and 24th month(all P<0.05).Conclusion:It would not increase recurrence risk that the olanzapine dose is gradually reduced to the lowest effective dose in treating patients with first-episode schizophrenia in maintenance phase,which could also improve patients’negative symptoms,adverse reactions,and social function.