中国十省市第一代及第二代抗精神病药使用现况调查

摘要

Objective: To investigate the status of the first and second generation antipsychotic drags application in schizophrenia in China and to identify the related factors. Methods: Information on schizophrenia patients meeting the criteria of the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) were extracted from the database of the second survey of the research on China Psychotropic Prescription Patterns Study in 2006. Totally 4232 patients with schizophrenia were identified who were treated with one single antipsychotic medication. The patients were divided into first-generation antipsychotics (FGAs) group and second-generation antipsychotics (SGAs) group. The difference of data between the groups was compared. Results: The use frequency of SGAs were significantly higher than that of FGAs (70. 8% vs. 29. 2, P <0. 01). Antipsychotic medication most frequently prescribed was risperidone (31. 1%), subsequently were clozapine (24.0%), sulpiride (10. 3%), chlorpromazine (9.7%), perphenazine (8.4%) and quetiapine (5. 9%). Compared with the SGAs group, FGAs group had older age, higher proportions of males and patients with family history, longer duration, lower family income, fewer clinic visits, and more episodes (Ps <0. 05). Besides, the rates of the symptoms including paranoid hallucinations state, verbal behavior confusion, increased speech activity and aggressive behaviors was significantly higher in the SGAs group than in the FGA group (Ps <0. 05); the rates of negative symptoms was lower in SGAs group than in the FGAs group (P <0. 01). Logistic analysis showed that the patients who were in Jiangxi (OR = 1. 29) and Sichuan (OR = 1. 08), engaged in agricultural labor (OR = 1. 21) and had older age (OR = 1. 02), more episodes (OR = 1.03) were more likely to choose FGAs. Conclusion:It suggests that in China, SGAs predominate in the treatment of schizophrenia.%目的:调查中国十省市第一代及第二代抗精神病药治疗精神分裂症的使用现况,并初步分析其相关因素.方法:选择2006年全国第2次精神药物处方方式调查中,符合国际疾病和相关健康问题分类第十版(ICD-10)精神分裂症诊断标准,并且接受单一、非长效抗精神病药治疗的4232例患者为研究对象,收集一般资料、临床症状及抗精神病药物使用情况等数据.结果:第二代抗精神病药使用比例明显高于第一代抗精神病药(70.8％vs.29.2％,P＜0.01).使用频率居前6位的药物依次是利培酮(31.1％)、氯氮平(24.0％)、舒必利(10.3％)、氯丙嗪(9.7％)、奋乃静(8.4％)和喹硫平(5.9％).与使用第二代药物的患者相比,使用第一代药物的患者年龄较大,男性比例较高,有家族史的比例较大,病程较长,家庭收入较低,就诊次数较少,发作次数较多(均P ＜0.05);使用第二代药物的患者中妄想幻觉状态、言语行为紊乱、言语活动增多及攻击症状出现的比例高于使用第一代药物的患者(均P ＜0.05),而阴性症状出现的比例较低(P＜0.01).Logistic回归分析显示,江西(OR=1.29)和四川(OR=1.08)、年龄大(OR=1.02)、发作次数多(OR=1.03)、从事农业劳动(OR=1.21)的患者更倾向于选择第一代抗精神病药(均P＜0.01).结论:第二代抗精神病药在我国精神分裂症患者的治疗中占主导地位.