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帕利哌酮和阿立哌唑对首发急性期精神分裂症的临床疗效及相关机制
宋佳黄卓玮柳小波钟宝亮
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摘要:
目的 探究帕利哌酮和阿立哌唑对首发急性期精神分裂症的临床疗效、社会功能恢复及 血清脑源性神经营养因子(BDNF)水平、事件相关脑电位N400 的影响。方法 应用随机、双盲、对照的 研究方法,选取2016 年8 月至2018 年8 月于武汉市精神卫生中心就诊的首发急性期精神分裂症患者 80 例,按随机数字表法将患者分为观察组和对照组,各40 例。对照组患者给予阿立哌唑片,初始剂量 每日10 mg,根据病情每周每日增加5 mg,最大剂量为每日30 mg。观察组患者给予帕利哌酮缓释片,初 始剂量每日6 mg,根据病情每周每日增加3 mg,最大剂量为每日12 mg。连续治疗8周,观察两组患者临 床疗效及不良反应,比较两组患者社会功能恢复情况、BDNF水平及事件相关电位N400变化。结果 观 察组患者总有效率(92.50%)显著高于对照组(75.00%)(P< 0.05)。治疗后两组患者阳性与阴性症状量 表(PANSS)评分显著低于治疗前,个人和社会功能量表(PSP)评分显著高于治疗前(P < 0.01);治疗后 观察组患者PANSS 评分显著低于对照组,PSP评分显著高于对照组(P< 0.01)。治疗后两组患者BDNF 水平均显著高于治疗前(P < 0.05);且观察组患者BDNF水平显著高于对照组(P < 0.05)。在匹配条件 下,治疗后两组患者N400 潜伏期显著短于治疗前(P< 0.01),波幅高于治疗前(P< 0.01);在非匹配条件 下,治疗后观察组患者N400 潜伏期显著短于治疗前(P< 0.05)。治疗后观察组和对照组TESS 评分分 别为(4.87±1.28)、(5.01±1.34)分,差异无统计学意义。观察组患者不良反应发生率(27.50%)与对照组 (22.50%)相比差异无统计学意义(P>0.05)。结论 帕利哌酮和阿立哌唑治疗精神分裂症患者疗效显著, 可有效改善患者社会功能及认知功能,有效调节BDNF水平及事件相关电位N400 变化,耐受性好,值得 临床推广。
关键词:  精神分裂症  脑源性神经营养因子  帕利哌酮  阿立哌唑  社会功能  事件相关电位
DOI:10.3969/j.issn.1009-6574.2019.05.006
基金项目:国家自然科学基金资助项目(71774060)
Effect of paliperidone and aripiprazole on the clinical efficacy, social function recovery, serumBDNF level and event-related brain potential N400 in first-episode acute schizophrenia
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Abstract:
Objectives To explore the effect of Paliperidone and Aripiprazole on the clinical efficacy, social function recovery, serum brain-derived neurotrophic factor( BDNF) level and event-related brain potential N400 in first-episode acute schizophrenia. Methods This is a randomized, double-blind, controlled study. A total of 80 patients with first-episode acute schizophrenia who were treated in our hospital from August 2016 to August 2018 were selected and divided into observation group and control group according to random number table method, with 40 cases in each group. The patients in the control group were given Aripiprazole tablets with an initial dose of 10 mg per day, which was later increased by 5 mg per week according to their condition. The maximum dose was 30 mg per day. The patients in the observation group were given Paliperidone sustained-release tablets with an initial dose of 6 mg per day, which was increased by 3 mg per week according to their condition. The maximum dose was 12 mg per day. Both groups were treated continuously for 8 weeks. The clinical efficacy and adverse reactions in the two groups were observed. The recovery of social function, the level of BDNF and the change of event-related potential N400 were compared between the two groups. Results The total effective rate was 92.50% in the observation group, which was significantly higher than the 75% effective rate in the control group( P<0.05). After the treatment, the positive and negative symptoms scale( PANSS) scores of the two groups were both significantly lower than before the treatment, and the personal and social function scale( PSP) scores of the two groups were both significantly higher than before the treatment (P < 0.01). After the treatment, the PANSS score of the observation group was significantly lower than the control group, and the PSP score was significantly higher than the control group( P<0.01). After the treatment, the levels of BDNF in both groups were significantly higher than before the treatment( P < 0.05), and the levels of BDNF in the observation group were significantly higher than the control group( P<0.05). Under the matching conditions, the N400 latencies after the treatment were significantly shorter than before the treatment in both groups( P<0.01), and the amplitude was higher than before the treatment( P<0.01). Under the nonmatching conditions, the N400 latency of the observation group after treatment was significantly shorter than before the treatment( P < 0.05). After the treatment, the Treatment Emergent Symptom Scale( TESS) scores were( 4.87±1.28) in the observation group, and( 5.01±1.34) in the control group which showed no significant difference( P > 0.05). There was no significant difference in the incidence of adverse reactions between the observation group( 27.50%) and the control group( 22.50%)( P>0.05). Conclusions Paliperidone is effective in the treatment of schizophrenia. It can effectively improve the social and cognitive functions of patients, effectively regulate the level of BDNF and the change of event-related potential N400. It is well tolerated and worthy of clinical promotion.
Key words:  Schizophrenia  Brain-derived neurotrophic factor  Paliperidone  Aripiprazole  Social function  Event-related potential

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