目的:研究齐拉西酮和奥氮平对首次接受治疗的精神分裂症急性期疗效及代谢的影响.方法:将80例首次接受治疗的精神分裂症患者分为奥氮平组(44例)和齐拉西酮组(36例),分别给予奥氮平和齐拉西酮单药治疗4周.在治疗基线和4周末,分别检测体质量、血糖、血脂等相关代谢指标,并用阳性症状与阴性症状量表(PANSS)评定疗效.结果:①治疗后,奥氮平组PANSS总分及阳性因子分、阴性因子分、一般精神病理因子分[分别为(62±16)、(13±5)、(16±5)、(28±6)]较基线[分别为(104±14)、(25±5)、(24±6)、(44±6)]明显下降,齐拉西酮组PANSS总分及阳性因子分、阴性因子分、一般精神病理因子分[分别为(73±21)、(16±5)、(19±8)、(33±10)]较基线[分别为(105±17)、(23±3)、(26±8)、(45±13)]明显下降,比较差异具统计学意义(P＜0.01)；奥氮平组PANSS总分、阳性症状分的改善优于齐拉西酮组(P＜0.05).②治疗后,齐拉西酮组体质量和BMI略增加(P＜0.05),奥氮平组体质量、BMI、腰围、腰臀比、胰岛素、胰岛素抵抗指数、总胆固醇、甘油三脂、LDL及载脂蛋白B100显著增高(P＜0.01)；奥氮平组体质量、腰围、腰臀比、总胆固醇、LDL、载脂蛋白B100均高于齐拉西酮组(P＜0.05或0.01).结论:齐拉西酮和奥氮平对首次接受治疗的精神分裂症急性期均具有确切疗效,两者对阴性症状和一般精神病理症状疗效相似,奥氮平对急性期患者阳性症状的改善优于齐拉西酮.与奥氮平相比,齐拉西酮对首次治疗的精神分裂症急性期的体质量影响轻微,对血糖血脂几乎没有影响.%Objective; To study the efficacy of Ziprasidone and Olanzapine in first-visiting patients with acute schizophrenia and the effect on metabolic index. Methods: Eighty inpatients with drug-naive acute schizophrenia were divided into either Olanzapine group (n = 44) or Ziprasidone group (n =36) for 4 weeks'treatment At baseline and the end of observation, The relevant metabolic index level (lipidemia, FBS, insulin, C-peptide, insulin resistence, BMI, waist circumference) were tested respectively, the Positive and Negative Syndrome Scale (PANSS) were evaluated before and after treatment respectively. Results: ①After treatment, the scores of PAN-SS [ respectively, (62 ± 16) for total、(13 ± 5) for positive、(16 ± 5) for negative、(28 ± 6 ) for general psychopa-thology] in Olanzapine group were significantly lower than baseline level [respectively, (104 ±14) for total、 (25 ±5) for positive、(24 ±6) for negative、(44 ±6) for general psychopathology ] (P < 0. 01). The scores of PANSS [ respectively, (73 ± 21)、(16 ± 5)、(19 ±8)、(33 ±10)] after treatment in Ziprasidone group were significantly lower than baseline [ respectively, (105 ± 17)、(23 ± 3)、(26 ± 8)、(45 ±13) ] (P < 0. 01). The decrease of PANSS total score as well as positive subscale score in Olanzapine group were significantly larger than those in Ziprasidone group(P < 0. 01 ). ②After treatment, both weight and BMI in Ziprasidone group increased mildly(P <0. 05) , however, in Olanzapine group, these metabolic index (including weight, BMI, waist circumference, W/H, insulin, insulin resistence, total cholesterol, triglyceride, LDL, apolipo-protein B100) substantially increased(P <0.01). The rise of weight, waist circumference, W/H, TC, LDL and apolipo-protein B100 in Olanzapine group was far bigger than Ziprasidone group after treatment(P <0. 01). Conclusion; Good efficacy was observed among drug-naived acute schizophrenia treated with either Ziprasidone or Olanzapine, similar improvement for negative symptom and general psychopathology were observed among Ziprasidone and Olanzapine group, but Olanzapine showed better efficacy on positive symptom. Comparatively speaking, Ziprasidone has only mild effect on BMI of drug-naived acute schizophrenia and hardly effect on relevant blood glucose and lipidemia.
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