目的 比较阿立哌唑和利培酮在精神分裂症伴代谢综合征患者中的临床疗效.方法 回顾性队列分析精神分裂症伴代谢综合征患者病历资料,根据治疗方法分为利培酮组和阿立哌唑组.利培酮组口服利培酮,每次2 mg,每日2次;阿立哌唑组口服阿立哌唑,每次5 mg,每日1次.2组均连续服用24周,同时进行生活方式干预.比较2组患者的临床疗效、阳性与阴性症状量表(PANSS)评分、代谢综合征相关指标[收缩压(SBP)、舒张压(DBP)、体质量指数(BMI)、空腹血糖(FPG)和三酰甘油(TG)]、认知功能[用精神分裂症认知功能成套测验共识版(MCCB)评估]、血清脑源性神经营养因子(BDNF)及受体酪氨酸激酶受体B(TrkB)、胶质细胞源性神经营养因子(GDNF)水平,并统计药物不良反应发生情况.结果 利培酮组和阿立哌唑组各60例.阿立哌唑组与利培酮组的总有效率分别为91.67％和76.67％,差异有统计学意义(P＜0.05).治疗后阿立哌唑组和利培酮组PANSS量表中阳性症状评分为(10.04±1.55)和(11.52±1.62)分,阴性症状评分为(12.74±2.38)和(14.38±2.25)分,一般精神病理评分为(16.53±4.39)和(19.76±4.10)分,PANSS 总分为(39.31±6.25)和(45.66±6.71)分,MCCB 量表总分为(43.61±8.55)和(40.55±8.16)分,BMI 为(24.05±2.52)和(25.73±2.86)kg·m-2,SBP 为(123.61±7.64)和(128.75±8.59)mmHg,FPG 为(5.69±0.60)和(6.38±0.62)mmol·L-1,TG 为(1.76±0.20)和(2.01±0.22)mmol·L-1,血清 BDNF 为(32.41±5.81)和(28.65±4.87)pg·mL-1,TrkB 为(43.88±5.92)和(41.73±5.63)ng·mL-1,GDNF 为(587.47±36.12)和(468.23±35.68)pg·mL-1,在统计学上差异均有统计学意义(均P＜0.05).阿立哌唑组与利培酮组的药物不良反应发生率(15.00％vs.6.67％)的比较,在统计学上差异无统计学意义(P＞0.05).结论 阿立哌唑治疗精神分裂症伴代谢综合征疗效优于利培酮,对患者体质量、血压和糖脂代谢影响更小,可能通过提升血清BDNF、TrkB和GDNF水平改善认知功能.
Objective To compare the clinical effect of aripiprazole and risperidone in patients with schizophrenia and metabolic syndrome.Methods A retrospective analysis was performed on the case data of schizophrenia and metabolic syndrome.According to different treatment methods,they were divided into risperidone group(oral risperidone,2 mg once,twice a day)and aripiprazole group(oral aripiprazole,5 mg once,once a day).All were treated for 24 weeks and given lifestyle intervention.The clinical effect,scores of positive and negative symptom scale(PANSS),metabolic syndrome-related indexes[systolic blood pressure(SBP),diastolic blood pressure(DBP),body mass index(BMI),fasting blood glucose(FPG),triglyceride(TG)],cognitive function[MATRICS consensus cognitive battery(MCCB)],levels of serum brain-derived neurotrophic factor(BDNF),tyrosine kinase receptor B(TrkB)and glial cell line-derived neurotrophic factor(GDNF)were compared between the two groups.The adverse drug reactions were statistically analyzed in two groups.Results There were 60 cases in risperidone group and 60 cases in aripiprazole group.The total response rates of aripiprazole group and risperidone group were 91.67％and 76.67％,with significant difference(P＜0.05).After treatment,scores of positive symptoms in PANSS in aripiprazole group and risperidone group were(10.04±1.55)and(11.52±1.62)points;negative symptom scores were(12.74±2.38)and(14.38±2.25)points;general psychopathology scores were(16.53±4.39)and(19.76±4.10)points;total scores of PANSS were(39.31±6.25)and(45.66±6.71)points;total scores of MCCB were(43.61±8.50)and(40.55±8.16)points;BMI were(24.05±2.52)and(25.73±2.86)kg·m-2;SBP were(123.61±7.64)and(128.75±8.59)mmHg;FPG were(5.69±0.60)and(6.38±0.62)mmol·L-1;TG levels were(1.76±0.20)and(2.01±0.22)mmol·L-1;levels of serum BDNF were(32.41±5.81)and(28.65±4.87)pg·mL-1;TrkB levels were(43.88±5.92)and(41.73±5.63)ng·mL-1;GDNF levels were(587.47±36.12)and(468.23±35.68)pg·mL-1,the differences between the two groups were all statistically significant(all P＜0.05).There was no significant difference in the incidence of adverse drug reactions between aripiprazole group and risperidone group(15.00％vs.6.67％,P＞0.05).Conclusion Compared with risperidone,clinical effect of aripiprazole is better in patients with schizophrenia and metabolic syndrome,which has fewer effects on body weight,blood pressure and glycolipid metabolism,and it may improve cognitive function by increasing levels of serum BDNF,TrkB and GDNF.
陈海峰;孔令军;曹波;李多聪
吉安市第三人民医院精神科,江西 吉安 343000
药学
阿立哌唑;利培酮;精神分裂症;代谢综合征;糖脂代谢;认知功能
aripiprazole;risperidone;schizophrenia;metabolic syndrome;glycolipid metabolism;cognitive function
《中国临床药理学杂志》 2024 (008)
1126-1130 / 5
10.13699/j.cnki.1001-6821.2024.08.008
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