丙戊酸镁与齐拉西酮对双相障碍Ⅰ型急性躁狂或混合发作疗效的研究  

Efficacy of magnesium valproate and ziprasidone in the treatment of acute manic episode or mixed episode of bipolar disorder type I

作　　者：杨程翔 李强[1,2] 万雅洁 刘莎 王骁[1,2] 孙跃红 徐勇 YANG Chengxiang;LI Qiang;WAN Yajie(The First Hospital of Shanxi Medical University/The First Clinical Medical College, Taiyuan 030001, China)

机构地区：[1]山西医科大学第一医院/第一临床医学院,山西太原030001 [2]精神障碍人工智能辅助诊疗山西省重点实验室 [3]山西省人民医院

出　　处：《精神医学杂志》2021年第3期193-197,共5页Journal of Psychiatry

基　　金：国家重点研发计划(编号:2016YFC1307004);国家自然科学基金项目(编号:81971601,81701326);山西省科技成果转化引导专项(编号:201904D131020);山西省卫健委科研课题(编号:2018GW01);认知障碍多学科诊疗山西省科技创新团队(编号:201705D131027)。

摘　　要：目的探讨齐拉西酮、丙戊酸镁和丙戊酸镁联用齐拉西酮对双相障碍1型急性躁狂或混合发作的疗效。方法选取双相障碍Ⅰ型患者100例,随机分为3组丙戊酸镁组,齐拉西酮组,丙戊酸镁+齐拉西酮组。使用杨氏躁狂量表(YMRS)、临床大体印象量表(CGI)、汉密尔顿抑郁量表(HAMD)、汉密尔顿焦虑量表(HAMA)对药效进行评估。并使用精神科药物不良反应量表(UKU)中的不良反应量表评定药物不良反应。结果以时间为主效应显示,三组YMRS评分均呈下降趋势(P<0.05),进一步比较结果显示,三组YMRS评分治疗后第2周末均低于基线,治疗后第4周末均低于治疗后第2周末,治疗后第8周末均低于治疗后第4周末(P<0.05)。以组别为主效应显示,三组YMRS评分比较差异有统计学意义(P<0.05)。治疗后第4周末三组YMRS评分比较差异有统计学意义(P<0.05),进一步两两比较结果显示,丙戊酸镁+齐拉西酮组YMRS评分低于丙戊酸镁组、齐拉西酮组(P<0.05)。以时间主效应显示,三组HAMA、HAMD评分呈下降趋势(P<0.05)。治疗后第4周末三组HAMA评分和治疗后第8周末三组HAMA、HAMD评分比较差异有统计学意义(P<0.05)。进一步两两比较结果显示,治疗后第4、8周末齐拉西酮组和丙戊酸镁+齐拉西酮组HAMA评分均低于丙戊酸镁组(P<0.05),治疗后第8周末齐拉西酮组HAMD评分低于丙戊酸镁组(P<0.05)。三组不良反应发生率比较差异有统计学意义(P<0.01)。齐拉西酮组与丙戊酸镁+齐拉西酮组不良反应发生率均低于丙戊酸镁组(P<0.01)。结论治疗双相障碍Ⅰ型急性躁狂或混合发作患者,单用齐拉西酮与单用丙戊酸镁疗效相当,丙戊酸镁联合齐拉西酮较两药单用可以加快急性期症状改善。丙戊酸镁联合齐拉西酮与单用齐拉西酮不良反应发生率相当,均低于单用丙戊酸镁。Objective To explore the efficacy of ziprasidone,magnesium valproate and magnesium valproate combined with ziprasidone in the treatment of bipolar disorder type I acute manic episode or mixed episode.Methods A total of 100 patients with bipolar disorder type I were randomly divided into three groups:magnesium valproate group,ziprasidone group,magnesium valproate+ziprasidone group and assessed with Young Mania Rating Scale(YMRS),Clinical Global Impression(CGI),Hamilton Depression Scale(HAMD),Hamilton Anxiety Scale(HAMA)and Udvalg for Kliniske Undersogelser(UKU)side effects scale.Results Taking time as the main effect,the total scores of YMRS in three groups decreased significantly(P<0.05),and the total scores of YMRS in three groups at the baseline>those at the 2nd weekend>those at the 4th weekend>those at the 8th weekend(P<0.05).Taking group as the main effect,there existed significant differences in the total scores of YMRS among three groups(P<0.05);at the 4th weekend,the total score of YMRS in magnesium valproate+ziprasidone group was significantly lower than those in magnesium valproate group and ziprasidone group(P<0.05).Taking time as the main effect,the total scores of HAMA and HAMD in three groups decreased significantly(P<0.05).There existed significant differences in the total scores of HAMA among three groups at the 4th weekend(P<0.05),and in the total scores of HAMA,HAMD among three groups at the 8th weekend(P<0.05).At the 4th,8th weekends,the total scores of HAMA in ziprasidone group and magnesium valproate+ziprasidone group were significantly lower than those in magnesium valproate group(P<0.05).At the 8th weekend,the total score of HAMD in ziprasidone group was significantly lower than that in magnesium valproate group(P<0.05).There existed significant difference in the incidence rates of adverse reactions among three groups(P<0.01),and the incidence rates of adverse reactions in ziprasidone group and magnesium valproate+ziprasidone group were significantly lower than that in magnesium valproate gr

关 键 词：双相障碍Ⅰ型 急性躁狂发作 混合发作 齐拉西酮 丙戊酸镁 

分 类 号：R749.4[医药卫生—神经病学与精神病学]