抗精神病药物治疗急性期精神分裂症的早期反应情况及相关因素的分析  

Analysis of early response to the antipsychotic treatment and related factors in acute schizophrenia patients

作　　者：孙梦夕 马骏[1] 王潇[1] 杨勇锋[1] 李文强[1] 张燕[2] 赵晶媛[2] 杜云红[2] 张红星[2] 张岱[3] 吕路线[1] 

机构地区：[1]新乡医学院第二附属医院重点实验室,453002 [2]新乡医学院第二附属医院精神科,453002 [3]北京大学第六医院

出　　处：《中华医学杂志》2017年第31期2425-2430,共6页National Medical Journal of China

基　　金：国家自然科学基金（81371472,U1404811）;国家科技部科技支撑计划（2015BAI13801）;河南省基础与前沿技术研究计划（132300413216）;新乡市重点科技攻关计划项目（ZG14002）

摘　　要：目的 探讨急性期精神分裂症治疗的早期反应与后期疗效之间的关联,以及药物与早期反应的关系.方法 回顾性分析2010年5月至2011年9月于新乡医学院第二附属医院住院治疗的146例精神分裂症患者的临床资料,将患者分为早期反应组（2周末PANSS总分减分率≥20%）和早期无反应组,比较两组一般资料、药物使用情况和基线、2、4、6周末的阳性和阴性症状量表（PANSS）;采用相关分析、回归分析得出早期治疗反应与后期疗效的关系及药物选择对早期反应的影响.结果 2、4、6周末,早期反应组较早期无反应组的PANSS总分及五因子分低[2、4、6周末总分（66.2±11.8）分比（84.5±10.9）分,（55.9±13.2）分比（70.9±13.7）分,（48.9±13.1）分比（60.6±14.9）分,均P〈0.05],减分率高[2、4、6周末总分减分率（37±14）%比（9±7）%,（56±19）%比（32±18）%,（68±20）%比（49±21）%,均P〈0.05];2周末与4、6周末PANSS总分减分率相关系数r分别为0.730、0.541（均P〈0.05）;2、4周末,奥氮平组PANSS总分减分率高于阿立哌唑、喹硫平、齐拉西酮组[2周末（29±19）%比（19±16）%、（18±14）%、（17±15）%,4周末（51±21）%比（37±25）%、（39±18）%、（37±22）%,均P〈0.05];早期反应的保护性因素是奥氮平治疗（P〈0.05）.结论 早期反应者的症状改善更迅速更明显;药物种类对早期反应有影响;早期无反应的患者可以通过及早调整治疗方案获益.Objective The objective was to assess the relationship between early response and later response to antipsychotics,and the relationship between antipsychotics and early response.Methods Data were retrospectively analyzed from patients with schizophrenia and they were hospitalized in the Second Affiliated Hospital of Xinxiang Medical College from May, 2013 to September, 2015.The patients were divided into theearly response group （PANSS total score improvement ≥20% at week 2） and early nonresponse group.General information, the use of drug and the Positive and Negative Syndrome Scale （PANSS） on before and 2,4,6 weeks after treatment were compared between the two groups.The relation between early response and late response and the effect of drug selection on early response were analyzed by correlation analysis and regression analysis.Results Relative to early nonresponders, early responders were significantly more likely to have lower PANSS scores （total scores on 2,4,6 weeks after treatment 66.2±11.8 vs 84.5±10.9, 55.9±13.2 vs 70.9±13.7, 48.9±13.1 vs 60.6±14.9, all P〈0.05） and higher PANSS scores improvement at 2,4,6 weeks after treatment （total scores improvement on 2,4,6 weeks after treatment （37±14）% vs （9±7）%, （56±19）% vs （32±18）%, （68±20）% vs （49±21）%,all P〈0.05）.The correlation coefficient between PANSS total score improvement at week 2 and at week 4,6 were 0.730 and 0.541,respectively （all P〈0.05）.Olanzapine had more PANSS total score improvement than aripiprazole, quetiapine and ziprasidone （2 weeks after treatment （29±19）% vs （19±16）%,（18±15）%,（17±15）%, 4 weeks after treatment （51±21）% vs （37±25）%,（39±18）%,（37±22）%,all P〈0.05）.The protective factor for early response was olanzapine （P〈0.05）.Conclusions Early responders are associated with faster and greater improvement in symptoms, the type of antipsychotic has impacts on early response, early non-responders can benefit from adjustment of tre

关 键 词：精神分裂症 抗精神病药 早期反应 奥氮平 

分 类 号：R749.3[医药卫生—神经病学与精神病学]