喹硫平联合碳酸锂治疗双相情感障碍躁狂发作的临床效果研究

Clinical efficacy of quetiapine combined with lithium carbonate in the treatment of manic episodes of bipolar disorder

目的:研究喹硫平联合碳酸锂对双相情感障碍躁狂发作患者临床症状与认知功能的影响。方法:选取2020年1月—2023年8月本院心境障碍科收治的89例双相情感障碍躁狂发作患者,随机分为对照组(n=44例)与研究组(n=45例),对照组使用奥氮平+碳酸锂治疗,碳酸锂初始剂量500 mg/d,2次/d,维持剂量500~1500 mg/d,2次/d;奥氮平初始剂量5 mg/d,1次/d,维持剂量5~20 mg/d,1~2次/d。研究组使用喹硫平+碳酸锂治疗,其中碳酸锂的用法用量同对照组;富马酸喹硫平初始剂量50 mg/次,2次/d,维持剂量300~600 mg/d,2次/d。8周后比较两组患者的血清超氧化物歧化酶(SOD)、肿瘤坏死因子α(TNF-α)、贝克-拉范森躁狂量表(BRMS)评分、阳性与阴性症状量表(PANSS)评分、韦氏成人智力量表(WAIS-RC)评分、简易精神状态检查量表(MMSE)评分和不良反应发生率。结果:治疗前两组SOD和TNF-α比较无统计学差异(P>0.05);治疗8周后,两组SOD和TNF-α显著低于治疗前(P<0.05),且研究组显著低于对照组(P<0.05)。治疗前两组BRMS和PANSS评分比较无统计学差异(P>0.05);治疗8周后,两组BRMS和PANSS评分显著低于治疗前(P<0.05),且研究组BRMS评分显著低于对照组(P<0.05),两组的PANSS评分则无显著差异(P>0.05)。治疗前两组WAIS-RC和MMSE评分比较无统计学差异(P>0.05);治疗8周后,两组WAIS-RC和MMSE评分显著高于治疗前(P<0.05),但两组WAIS-RC和MMSE评分比较无统计学差异(P>0.05)。两组患者的不良反应发生率比较无显著差异(P>0.05)。结论:奥氮平+碳酸锂、喹硫平+碳酸锂均可缓解双相情感障碍躁狂发作患者的临床症状与认知功能,减轻机体炎性水平,并且不良反应较少。其中喹硫平+碳酸锂有利于更好地减轻应激反应,缓解阳性症状。临床可根据患者实际情况,合理选择用药方案。

Objective:To investigate the effects of quetiapine combined with lithium carbonate on clinical symptoms and cognitive function in manic episodes of bipolar disorder.Methods:89 patients with manic episodes of bipolar disorder admitted to the department of mood disorders in our hospital between January 2020 and August 2023 were randomly divided into a control group(44 patients)and a study group(45 patients).The control group was administered olanzapine and lithium carbonate.The initial dose of lithium carbonate was 500 mg/day,twice a day,and the maintenance dose was 500~1500 mg/d,twice a day.The initial dose of olanzapine was 5 mg/day once a day,and the maintenance dose was 5~20 mg/day,once or twice a day.The study group was treated with quetiapine and lithium carbonate,and the usage and dosage of lithium carbonate were the same as those in the control group.The initial dose of quetiapine fumarate was 50 mg/time,twice a day,and the maintenance dose was 300~600 mg/d,twice a day.After eight weeks,serum superoxide dismutase(SOD),tumor necrosis factor-α(TNF-α),Baker-Raphson Mania Scale(BRMS),Positive and Negative Symptom Scale(PANSS),Wechsler Adult Intelligence Scale(WAIS-RC),Mini Mental State Examination Scale(MMSE),and the incidence of adverse reactions were compared between the two groups.Results:There were no statistically significant differences in SOD and TNF-αlevels between the two groups before treatment(P>0.05).After eight weeks of treatment,SOD and TNF-αlevels in the two groups were significantly lower than before treatment(P<0.05),and the levels in the study group were significantly lower than those in the control group(P<0.05).There was no significant difference in the BRMS and PANSS scores between the two groups before treatment(P>0.05).After eight weeks of treatment,the BRMS and PANSS scores of the two groups were significantly lower than those before treatment(P<0.05),and the BRMS scores of the study group were significantly lower than those of the control group(P<0.05),but there was no significant difference between the two groups(P>0.05).There was no significant difference in the WAIS-RC and MMSE scores between the two groups before treatment(P>0.05).After eight weeks of treatment,the WAIS-RC and MMSE scores of the two groups were significantly higher than those before treatment(P<0.05),but there was no statistical difference between the two groups(P>0.05).There was no significant difference in the incidence of adverse reactions between the two groups(P>0.05).Conclusion:Olanzapine combined with lithium carbonate and quetiapine combined with lithium carbonate can alleviate the clinical symptoms and cognitive function of patients with manic episodes of bipolar disorder,reduce the inflammatory level,and reduce adverse reactions.The combination of quetiapine and lithium carbonate is beneficial for reducing the stress response and relieving positive symptoms.Clinically,the medication scheme can be reasonably selected according to the actual situation of the patients.