齐拉西酮联合心境稳定剂治疗双相躁狂发作  

Ziprasidone with mood stabilizer in treatment of bipolar manic episodes

作　　者：陈正昕[1] 任志斌[1] 邱德胜[2] 潘集阳[3] 范学胜[4] 孙剑[5] 陈炯[1] 邢葆平[1] 王鹤秋[1] 金卫东[1] 王伟[6] 

机构地区：[1]浙江中医药大学附属同德医院(浙江省立同德医院,浙江省精神卫生中心) [2]武汉大学人民医院精神科 [3]暨南大学附属第一医院精神科 [4]中国医科大学附属第一医院精神科 [5]全军精神卫生中心 [6]浙江大学医学院

出　　处：《中华全科医学》2014年第5期682-684,817,共4页Chinese Journal of General Practice

摘　　要：目的观察齐拉西酮与奥氮平合并碳酸锂或丙戊酸钠治疗躁狂发作的疗效和安全性。方法对符合DMS-V躁狂发作和混合发作诊断标准的100例研究对象随机分成2组,试验组应用齐拉西酮合并碳酸锂或丙戊酸钠(齐拉西酮组),对照组奥氮平联合碳酸锂或丙戊酸钠(奥氮平组),治疗观察8周。采用杨氏躁狂量表(YMRS)评定疗效和简明精神病评定量表(BPRS),以副反应量表(TESS)及实验室有关辅助检查评价疗效和安全性。结果 2组在治疗前后YMRS均有显著降低(F=22.5,P<0.01;F=16.1,P<0.01),BPRS也有类似结果 (F=12.8,P<0.01;F=6.9,P<0.01)。齐拉西酮组YMRS在治疗第1周末的评分比奥氮平组高,减分比奥氮平组少,均有显著性差异。齐拉西酮组BPRS在治疗第1周末、2周末评分比奥氮平组高,减分比奥氮平组少,均有显著性差异。观察结束时两组间痊愈率、有效率差异均无统计学意义(痊愈率:42%、40%,χ2=0.02,P>0.05;有效率:80%、84%,χ2=0.54,P>0.05)。但是2组间药物副作用有差异,奥氮平组体重增加和血脂异常明显高于齐拉西酮。结论齐拉西酮、奥氮平合并碳酸锂或丙戊酸钠治疗躁狂发作的疗效均比较理想,但是奥氮平副作用偏多。Objective To compare the efficacy and safety of ziprasidone and olanzapine with lithium carbonate or sodium valproate in the treatment of bipolar manic episodes. Methods A total of 100 patients meeting criteria of manic episode or mixed episode of bipolar disorder in DSM-V were randomly divided into two groups. The experimental group received zi- prasidone with lithium carbonate or sodium valproate ,while the control group received olanzapine with lithium carbonate or sodium valproate. The course was 8 weeks. The Yong Manic Rating Scale （YMRS）, Brief Psychiatric Rating Scale （BPRS） and TESS were individually used for assessment of efficacy and safety. Results YMRS and BPRS of both groups de- creased after the treatment （ F = 22.5, P 〈 0.01, F = 16.10, P 〈 0.01 ; F = 12.8, P 〈 0.01, F = 6.9, P 〈 0.01 ）. And scale of YMRS at first weekend of the experimental group was significantly higher than that of the control group and its changes was less than that of olanzapine. Scale of BPRS at the first and second weekends of experimental group was significantly higher than that of control group, and its changes was less than that of control group. The difference in full remission rate and effective rate at 8th weekend of both two groups was significant（42% ,40% , X2 = 0.02,P 〉 0.05;80% ,84%, X2 = 0.54, P 〉 0.05 ）. But both groups had great difference in side effects. The numbers of weight gain, elevated cholesterol, el- evated triglycerides, and elevated low density ester protein in control group were higher than that in experimental group. Conclusion The effect of ziprasidone and olanzapine combination with lithium or valproate in the treatment of bipolar manic episodes is similar. But more side effect of olanzapine was found as compared to ziprasidone.

关 键 词：齐拉西酮 奥氮平 心境稳定剂 躁狂发作 双相障碍 

分 类 号：R971.4[医药卫生—药品] R749.41[医药卫生—药学]