Objective To determine the efficacy and safety of olanzapine in the treatment of childhood schizophrenia by using clozapine as a control.Methods All 60 cases with childhood schizophrenia were randomly divided into research group and control group (n =60 each group).The patients in research group took olanzaping with a starting dose 2.5 mg/d,and the patients in control group took clozaping with a starting dose 12.5 mg/d.The positive and negative syndrome scale(PANSS)and treatment emergent symptom scale(TESS)were used to evaluate the effect and adverse reaction before and after treatment for 8 weeks.Results There was no significant difference in curative effect between research group and control group [ 73.3％ (44/60)vs 76.7％ (46/60),P ＞ 0.05 ].The scores of PANSS in research group and control group after treatment for 8 weeks were lower than those before treatment [ research group:(41.8±13.1 )scores vs(81.2±13.7 )scores;control group:(43.2±13.5 )scores vs (79.2±10.5 )scores,all P＜0.05 ],and the scores of positive factors,negative factors,cognitive function,excitement/irritation and anxiety/depression in two groups after treatment for 8 weeks were lower than those before treatment.After treatment for 8 weeks,compared with control group,the scores of negative factors,cognitive function and anxiety/depression in research group decreased [ (17.4±7.3)scores vs(24.7±8.2)scores,(3.3±3.4)scores vs(8.2±4.2 )scores,(5.1±2.4 )scores vs (8.7±3.1 )scores,respectively,P＜0.05 or P＜0.01 ].The adverse reactions were mild dizzy [ 16.7％ (10/60 )],thirst [ 16.7％ (10/60 )] and weight gain [ 15.0％(9/60)] in research group and increased saliva [ 40.0％ (24/60 )],weight gain [ 40.0％ (24/60 )],mild dizzy [26.7％ (16/60)] in control group.The rates of adverse reaction about tachycardia,drowsiness,abnormal blood picture,increased saliva,nausea and vomitting,mild dizzy,weight gain,nasal congestion,blurred vision,constipation,hypotension,appetite enhancement in research group were lower than those in control group (all P ＜0.05).Conclusion Olanzapine is a safe,effective agent in the treatment of childhood schizophrenia,and can be used as first-line drug for treatment of childhood schizophrenia.%目的 以氯氮平为对照,探讨奥氮平治疗儿童精神分裂症的疗效与安全性.方法 将120例精神分裂症患者按入院顺序随机分成研究组和对照组,各60例.研究组患者服用奥氮平,起始剂量2.5 mg/d,第3天添加剂量至5 mg/d,此后视病情变化调节剂量,最大不超过15 mg/d；对照组患者服用氯氮平,起始剂量12.5 mg/d,1周内加到150 mg/d,此后视病情变化调节剂量,最大不超过300 mg/d.2组患者于治疗前和治疗8周末采用阳性和阴性症状量表(PANSS)和治疗意外症状量表(TESS)评定疗效和不良反应.结果 研究组总有效率为73.3％ (44/60),对照组总有效率为76.7％ (46/60)；2组患者总有效率比较,差异无统计学意义(P＞0.05).研究组和对照组治疗8周末,PANSS总分较治疗前均降低[研究组:(41.8±13.1)分比(81.2±13.7)分；对照组:(43.2±13.5)分比(79.2±10.5)分],阳性因子、阴性因子、认知功能、兴奋/激惹和焦虑/抑郁评分均较治疗前明显降低(均P ＜0.05).治疗8周末,研究组阴性因子、认知功能及焦虑/抑郁评分均明显低于对照组[分别为( 17.4±7.3)分比(24.7±8.2)分、(3.3±3.4)分比(8.2±4.2)分、(5.1±2.4)分比(8.7±3.1)分],差异均有统计学意义(P ＜0.05或P＜0.01).研究组主要不良反应为轻度头晕[ 16.7％ (10/60)]、口干[16.7％ (10/60)]、体重增加[15.0％ (9/60)]等,对照组主要不良反应为唾液增多[40.0％ (24/60)]、体重增加[40.0％ (24/60)]、轻度头晕[26.7％ (16/60)]等,研究组心动过速、嗜睡、血象异常、唾液增多、恶心呕吐、轻度头晕、体重增加、鼻塞、视力模糊、便秘、低血压、食欲增强发生率明显低于对照组(P＜0.05).结论 奥氮平是一种安全、有效的非典型抗精神病药物,可作为治疗儿童精神分裂症的一线用药.但因本研究仅限于12岁以上儿童,且研究时间短、样本量偏少,无法确切反映长时间治疗的疗效,有待于进一步大样本、长时间的研究.
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