利培酮、氯氮平与氯丙嗪的疗效和不良反应及相关因素的研究  

A comparative study on efficacy, adverse effects and correlative factors of risperidone, clozapine and chlorpromazine

作　　者：翁史旻[1] 陈圣祺[1] 钱敏才[1] 张光觐[1] 王志阳[1] 诸索宇[1] 潘桂花[1] 王克勋[1] 李华芳[1] 顾牛范[1] 

机构地区：[1]上海市精神卫生中心,200030

出　　处：《上海精神医学》2003年第4期210-214,共5页Shanghai Archives of Psychiatry

摘　　要：目的　比较利培酮、氯氮平与氯丙嗪的疗效和不良反应 ,探讨有关的实验室检查和药物浓度相互关系。方法　将符合CCMD 2 R诊断标准的精神分裂症患者 ,根据临床情况和入院顺序 ,分别进入利培酮组、氯氮平组与氯丙嗪组 ,观察 8周。以PANSS、CGI、TESS和ESRS量表评定药物的疗效和不良反应。同时测定血清泌乳素和药物浓度。结果　治疗 8周后 :①利培酮组、氯氮平线和氯丙嗪组的PANSS量表总分、阴性分量表、一般精神病理学分量表和CGI量表病情严重程度评分均下降 ,而利培酮组和氯氮平组减分较氯丙嗪组明显 (分别P <0 0 1,P <0 0 5 ) ,TESS及ESRS量表的评分也与氯丙嗪组有显著性差异 (分别为P <0 0 1,P <0 0 5 )。②利培酮组、氯氮平组与氯丙嗪组肝功能、心电图检查组间差异有非常显著意义 (均P <0 0 1)。③氯氮平的剂量与去甲氯氮平、氯氮平浓度呈显著相关 ,9 羟利培酮浓度与PRL、利培酮有效率呈显著性相关 ,氯丙嗪浓度与PRL呈显著性相关 (rs=0 .2 6 1,P =0 .0 15 )。结论　利培酮、氯氮平具有较强抗精神病作用 ,相对氯丙嗪更为有效和全面。利培酮的安全性相对较好。Objective: To compare the efficacy and advese events of risperidone, clozapine and chlorpromazine, to explore the relationship between results of lab tests and serum concentration of drugs. Methods: The patients who met CCMD 2 R criteria for schizophrenia were divided into 3 groups treated with risperidone (G1), clozapine (G2) and chlorpromazine (G3), respectively. PANSS, CGI, TESS and ESRS scales were used to evaluate efficacy and adverse effects of drugs, as well as serum concentration and prolactin before and after 8 week treatment. Results: ① After treatment, some of the scores in three groups were decreased significantly, including total scores of PANSS, scores of negative symptom and general psychopathology subscales, CGI subscale for disease severity, with the decreased rate in G1 and G2 more significant than in G3. ② Liver function and EKG of G3 were significantly different compared with G1 and G2. ③ Dose of clozapine was significantly associated with serum concentration of nor clozapine and clozapine. Serum concentration of 9 OH risperidone was significantly associated with serum prolactin and efficacy of risperidone. Serum concentration of chlorpromazine was significantly associated with serum prolactin. Conclusion: The results suggest that risperidone and clozapine are effective antipsychotic agent and more effective than chlorpromazine, while risperidone shows better safety profile.

关 键 词：利培酮 氯丙嗪 氯氮平 不良反应 血药浓度 

分 类 号：R749.3[医药卫生—神经病学与精神病学]