伴月经紊乱的精神分裂症女性患者换用喹硫平后一年的随访  

A one-year follow-up study of 33 female schizophrenic patients with menstrual disturbances after switching to quetiapine

作　　者：于靖[1] 王传跃[1] 翁永振[1] 刘瑞玫[2] 姜荣环[3] 邸晓兰[4] 姚付新[4] 王锦霞[4] 朱凤艳[4] 沈建华[5] 杨桂伏[5] 高昕[5] 何静[5] 

机构地区：[1]首都医科大学附属北京安定医院精神科,100088 [2]首都医科大学附属北京安定医院科研室,100088 [3]北京大学精神卫生研究所精神科 [4]北京回龙观医院精神科 [5]天津安定医院精神科

出　　处：《中华精神科杂志》2007年第3期161-164,共4页Chinese Journal of Psychiatry

摘　　要：目的评估因服用其他抗精神病药而出现月经紊乱的女性精神分裂症患者换用喹硫平后的月经变化,以及疗效和安全性。方法对33例经抗精神病药治疗出现月经紊乱的女性精神分裂症患者,换用喹硫平单一治疗52周,在2周内停用原抗精神病药。主要观察指标为月经情况及催乳素(PRL)、雌二醇(E_2)、睾酮、促甲状腺素、游离三碘甲状腺原胺酸、游离甲状腺素水平,次要观察指标为简明精神病量表(BPRS)、临床疗效总评量表-疾病严重程度(CGI-SI)、不自主运动量表(AIMS)和锥体外系反应量表(SAS)评分及实验室检查。结果 (1)喹硫平治疗后,20例闭经者中18例(90%)月经来潮。13例月经不规律者中11例明显改善;完成52周观察的15例中有13例月经量正常且恢复月经周期。14例分别因明显改善和月经恢复正常而提前退出。9例溢乳者的溢乳消失。(2)治疗第12,52周血清 E_2,T,TSH,FT_3,FT_4水平与基线的差异均无统计学意义(P>0.05)。(3)与基线比较,PRL 水平于第4～52周逐渐下降(P<0.01～0.05);BPRS评分于第4,8和52周下降(P<0.05);CGI-SI 评分于第52周下降(P<0.05);AIMS 评分于第12,26周和用末次观察结转法(LOCF)均下降(P<0.05);SAS 评分于第12,26周和 LOCF 下降(P<0.05)。(4)在整个研究中无严重不良反应发生。结论经换用喹硫平治疗后,患者催乳素水平显著下降,90%的患者月经恢复,但对内分泌的影响及长期疗效还有待进一步观察。Objective To assess the menstrual return, efficacy and tolerability of quetiapine in the treatment of female schizophrenic patients with antipsychotic-induced menstruation disturbances, Methods Thirty-three female schizophrenic patients with antipsychotic-induced menstruation disturbance were switched to quetiapine treatment for 52 weeks. The primary measures were menses status and blood prolactine （PRL）, estradiol （E2 ）, testosterone level and thyroid function. The Brief Psychiatric Rating Scale （BPRS）, Clinical Global Impression Severity of Illness （CGI-SI）, Abnormal Involuntary Movement Scale （AIMS） and Simpson-Angue Scale （SAS） were used to assess the symptoms and side effects. Results Eighteen of 20 patients with amenorrhea had menstrual onset, and 11 of 13 patients with menses irregulars had improvement obviously. In the 15 patients who finished the study, 13 reported having eumenorrhea. As to the reasons for withdraw in the 18 patients, 14 were having eumenorrhea or good improvement. All the 9 patients with galactorrhea were recovered. The PRL level declined from week 4 to week 52 in comparison to the baseline （ P 〈 0.01 - 0.05 ） , while there were no statistically significant difference in E2, T, TSH, FT3 and FT4 at week 12 and week 52 compared to the baseline （P 〉0. 05）. BPRS scores were declined at week 4, 8 and 52 （ P 〈 0. 05 ）, and CGI-SI score declined at week 52 （ P 〈 0.05 ）. There were statistically significant differences from baseline to week 12, 26 and 52 in AIMS and SAS scores （P 〈 0. 05 ）. No serious adverse events occurred during the study. Conclusions The results indicate that menses could recover in most patients with antipsychotic-induced menstruation disturbances in one year after switching to quetiapine, and further study of the long term effects of quetiapine on menstruation are needed in future.

关 键 词：精神分裂症 女(雌)性 月经失调 喹硫平 

分 类 号：R749.3[医药卫生—神经病学与精神病学]