精神分裂症患者氯氮平维持治疗的治疗依从性、剂量及浓度研究  

The drug-compliance, dose and concentration for the maintenance treatment of clozapine in schizophrenic patients

作　　者：王传跃[1] 向应强[1] 翁永振[1] 翟屹民[1] 李文标[1] 蔡焯基[1] 

机构地区：[1]首都医科大学附属北京安定医院,100088

出　　处：《中华精神科杂志》2001年第3期138-141,共4页Chinese Journal of Psychiatry

基　　金：北京卫生扶持学科基金资助项目;首都医学发展科研基金资助项目 ( 2D199816 )

摘　　要：目的　探讨精神分裂症患者氯氮平维持治疗的治疗依从性、剂量及浓度与预防复发 /恶化的关系。方法　对经氯氮平治疗后疗效达到明显好转而出院的 10 2例精神分裂症患者随访 1年。每月评定简明精神病评定量表 (BPRS) ,采用BPRS的核心条目 (4、7、11、12和 15 )判定是否复发 /恶化 ;每日评定服药依从性 ;每 2个月采集血样。结果　复发 /恶化率为 32 4% (33/ 10 2 )。复发 /恶化者的服药依从性明显低于未复发者 (P <0 0 0 1)。经运筹特性曲线法分析得出 ,未复发者氯氮平维持治疗的最低有效剂量为 137 5mg/d(灵敏度为 10 0 0 % ,特异度为 93 9% ) ,氯氮平最低有效血清浓度为132 0 μg/L(灵敏度为 10 0 0 % ,特异度为 93 9% ) ;氯氮平 +去甲氯氮平最低血清浓度为 2 0 1 0 μg/L(灵敏度为 98 6 % ,特异度为 97 0 % )。结论　对于经氯氮平治疗后疗效达到明显好转以上的精神分裂症患者 ,维持治疗时需提高服药依从性。氯氮平维持治疗的剂量应不低于 137 5mg/d ,氯氮平或氯氮平 +去甲氯氮平的血清浓度应分别不低于 132 0 μg/L和 2 0 1 0 μg/L。Objective The trial was to investigate the relationship between clozapine doses or concentrations for the maintenance treatment and preventing relapse in schizophrenic patients Methods A one year follow up study was carried out in 102 discharged schizophrenics who were much improved by clozapine treatment During this period, the Brief Psychiatric Rating Scales (BPRS) were evaluated monthly, and the major items of BPRS (4, 7, 11, 12, and 15 items) were used to assess whether the patients relapse or not; drug compliance was examined daily; blood samples were obtained every two months Results Thirty tree of 102 (32 4%) subjects met relapse criteria The drug compliance of relapse patients was significantly worse than that of non relapse patients ( P <0 001) For non relapse patients, a receiver operator curve demonstrated that the threshold clozapine dose for the maintenance treatment was 137 5 mg/d (sensitivity 100 0%, specificity 93 9%); the threshold clozapine serum concentration was 132 0 μg/L (sensitivity 100 0%, specificity 93 9%); the threshold serum concentration of clozapine plus norclozapine was 201 0 μg/L (sensitivity 98 6%, specificity 97 0%) Conclusions For the schizophrenic patients who were much improved by clozapine treatment, it is necessary to increase drug compliance for the maintenance treatment Clozapine maintenance doses should not be lower than 137 5 mg/d; clozapine or clozapine plus norclozapine maintenance concentrations should not be lower than 132 0 μg/L or 201 0 μg/L, respectively.

关 键 词：精神分裂症 氯氮平 剂量效应关系 药物治疗依从性 剂量 浓度 

分 类 号：R749.3[医药卫生—神经病学与精神病学]