丙戊酸钠与改良型无抽搐电休克治疗对氯氮平抵抗的难治性精神分裂症疗效和安全性比较  

Comparison of efficacy and safety between sodium valproate andmodified electroconvulsive therapy in clozapine-resistant refractory schizophrenia(CRS)

作　　者：金莹 李觉[1] 朱明环 黄瑛 师典红 刘旻佳 JIN Ying;LI Jue;ZHU Minghuan;HUANG Ying;SHI Dianhong;LIU Minjia(School of Medicine,Tongji University,Shanghai 200092,China;Mental Health Center,School of Medicine,Tongji University,Shanghai 200124,China)

机构地区：[1]同济大学医学院,上海200092 [2]同济大学附属精神卫生中心,上海200124

出　　处：《同济大学学报（医学版）》2022年第3期388-393,共6页Journal of Tongji University(Medical Science)

基　　金：上海市浦东新区科技发展基金(PKJ2020-Y32)。

摘　　要：目的 比较丙戊酸钠与改良型无抽搐电休克治疗(modified electroconvulsive therapy, MECT)对氯氮平抵抗的难治性精神分裂症(Clozapine-resistant schizophrenia, CRS)疗效和安全性的差异。方法 本研究招募了90例CRS患者,进行为期8周随机对照试验,最终78例完成试验,脱落12例。将患者随机分为3组:(1) MECT联合氯氮平组(MC组)30例,完成28例、脱落2例;(2)丙戊酸钠联合氯氮平组(VC组)30例,完成27例、脱落3例;(3)维持原治疗组(对照组)30例,完成23例、脱落7例。采用阳性与阴性症状量表(The Positive and Negative Syndrome Scale, PANSS)评定临床疗效,采用血常规、血生化指标、体格检查及心电图评估安全性。结果 在治疗4周和8周后MC组PANSS精神病理分和PANSS总分均较入组前显著下降(P<0.05),而VC组和对照组均没有这种差异。PANSS阳性量表分和PANSS总分,干预与时间存在交互效应,简单效应分析发现只有PANSS总分存在组间差异。PANSS精神病理分存在组间差异(F=3.89,P=0.025)。同期组间对照比较发现治疗4周和8周的PANSS精神病理分以及治疗8周的PANSS总分减分幅度大于VC组和对照组(P<0.05)。3组间安全性比较差异无统计学意义(P均>0.05)。结论 MECT联合治疗方案对CRS的疗效优于丙戊酸钠,且具有较好的安全性。Objective To compare the efficacy and safety between sodium valproate and MECT augmentation in clozapine-resistant refractory schizophrenia(CRS). Methods Seventy-eight CRS patients completed a 8-week-randomized clinical trial, including 28 cases received MECT combined with clozapine(MC group), 27 cases received valproate sodium combined with clozapine group(VC group) and 23 cases maintained the original treatment(control group). The clinical efficacy was evaluated by the Positive and Negative Syndrome Scale(PANSS), and the safety was evaluated by blood routine, blood biochemical index, physical examination, and electrocardiogram. Results After 4 and 8 weeks of treatment, the general psychopathology scale score of PANSS and the total score of PANSS in the MC group were significantly lower than those before treatment(P<0.05), but there were no significant changes in VC group and control group. There were interactive effects between intervention and time in positive score of PANSS and total score of PANSS. Simple effect analysis showed that only the total score of PANSS had a difference among 3 groups. The general psychopathology score of PANSS had a difference among 3 groups(F=3.89, P=0.025). The decrease ranges in the general psychopathology score of PANSS at 4 and 8 weeks and the total score of PANSS at 8 weeks in the MC group were significantly greater than those in the VC group and control group(P<0.05). There was no significant difference in safety among the three groups(all P>0.05). Conclusion The efficacy of MECT combined clozspine is better than that of sodium valproate in the treatment of CRS and there is no significant difference in the safety.

关 键 词：氯氮平抵抗的难治性精神分裂症 氯氮平 丙戊酸钠 改良型无抽搐电休克治疗 

分 类 号：R749.3[医药卫生—神经病学与精神病学]