首发女性精神分裂症患者药源性高泌乳素血症的用药分析
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摘要
目的比较舒肝颗粒与阿立哌唑对首发女性精神分裂症患者药源性高泌乳素血症的疗效与安全性。方法选择收治的药源性高泌乳素血症的首发女性精神分裂症患者180例,按随机数字表法分成对照组和研究组,每组90例。对照组给予阿立哌唑,10 mg/d;研究组给予舒肝颗粒每次1袋,2次/d,共治疗12周。比较2组患者泌乳素(prolactin,PRL)水平,阳性和阴性症状量表(positive and negative syndrome Scale,PANSS),治疗时出现的症状量表(treatment emergent symptom scale,TESS)及不良反应情况。结果 2组患者PRL水平均随治疗时间延长而下降(F_(时间)=9.73,P<0.05),对照组PRL水平下降幅度较研究组大(F_(交互)=4.36,P<0.05),2组患者PRL整体水平差异无统计学意义(F_(分组)=0.13,P>0.05)。2组患者PANSS总分均随治疗时间延长而下降(F_(时间)=23.89,P<0.05);且2组患者PANSS总分下降幅度基本一致(F_(交互)=0.98,P>0.05),2组患者PANSS总分的整体水平差异无统计学意义(F_(分组)=1.06,P>0.05)。2组患者TESS评分随治疗时间延长而上升(F_(时间)=19.56,P<0.05),研究组TESS评分上升幅度较对照组小(F_(交互)=9.16,P<0.05)研究组TESS评分整体水平显著低于对照组(F_(分组)=7.96,P<0.05)。研究组患者治疗4、8、12周不良反应均显著低于对照组(χ~2值分别为4.79、4.84、7.90,P<0.05)。结论舒肝颗粒治疗首发女性精神分裂症患者药源性高泌乳素血症的临床疗效与阿立哌唑疗效相当,不良反应明显少于阿立哌唑,具有更好的安全性。
Objective To compare the therapeutic effects and security of Shugan granule and aripiprazole on drug-induced hyperprolactinemia in women patients with first episode schizophrenia.Methods A total of 180 women patients with first episode schizophrenia combined with drug-induced hyperprolactinemia who were admitted and treated in our hospital were divided into control group(n=90) and research group(n=90) according to the random number table. The patients in control group were treated by aripiprazole 10 mg daily, however,the patients in research group were treated by Shugan granules 1 bag once, twice a day,with a treatment course of 12 weeks for both groups. The prolactin(PRL) levels, positive and negative syndrome scale(PANSS), treatment emergency symptom scale(TESS) and adverse reactions were observed and compared between the two groups.Results The PRL levels in both groups were decreased along with the treatment time extension(F time=9.73, P<0.05). Moreover the decrease extent of PRL level in control group was significantly larger than that in research group(F interaction=4.36, P<0.05). However there were no significant difference in the overall PRL levels between the two groups(F grouping=0.13, P>0.05). The total scores of PANSS in both groups were decreased along with the treatment time extension(F time=23.89, P<0.05). Moreover the decrease extent of PANSS in the two groups were basically similar(F interaction=0.98, P>0.05). In addition there were no significant differences in PANSS scores between the two groups(F grouping=1.06, P>0.05). The TESS scores in both groups were significantly increased along with the treatment time extension(F time=19.56, P<0.05). However the increase extent of TESS scores in research group was significantly lower than that in control group(F interaction=9.16, P<0.05). Moreover the TESS scores in research group were significantly lower than those in control group(F grouping=7.96, P<0.05). After 4-week,8-week,12-week treatment the incidence rates of adverse reactions in research group were significantly lower than those in control group( χ2= 4. 79,4. 84,7. 90,respectively,P < 0. 05). Conclusion The clinical efficacy of Shugan granule in treatment of drug-induced hyperprolactinemia in women patients with first episode schizophrenia is similar to aripiprazole,moreover the side effects and adverse reactions of Shugan granule are significantly less than those of aripiprazole,moreover,the latter has better safety.
Objective To compare the therapeutic effects and security of Shugan granule and aripiprazole on drug-induced hyperprolactinemia in women patients with first episode schizophrenia.Methods A total of 180 women patients with first episode schizophrenia combined with drug-induced hyperprolactinemia who were admitted and treated in our hospital were divided into control group(n=90) and research group(n=90) according to the random number table. The patients in control group were treated by aripiprazole 10 mg daily, however,the patients in research group were treated by Shugan granules 1 bag once, twice a day,with a treatment course of 12 weeks for both groups. The prolactin(PRL) levels, positive and negative syndrome scale(PANSS), treatment emergency symptom scale(TESS) and adverse reactions were observed and compared between the two groups.Results The PRL levels in both groups were decreased along with the treatment time extension(F time=9.73, P<0.05). Moreover the decrease extent of PRL level in control group was significantly larger than that in research group(F interaction=4.36, P<0.05). However there were no significant difference in the overall PRL levels between the two groups(F grouping=0.13, P>0.05). The total scores of PANSS in both groups were decreased along with the treatment time extension(F time=23.89, P<0.05). Moreover the decrease extent of PANSS in the two groups were basically similar(F interaction=0.98, P>0.05). In addition there were no significant differences in PANSS scores between the two groups(F grouping=1.06, P>0.05). The TESS scores in both groups were significantly increased along with the treatment time extension(F time=19.56, P<0.05). However the increase extent of TESS scores in research group was significantly lower than that in control group(F interaction=9.16, P<0.05). Moreover the TESS scores in research group were significantly lower than those in control group(F grouping=7.96, P<0.05). After 4-week,8-week,12-week treatment the incidence rates of adverse reactions in research group were significantly lower than those in control group( χ2= 4. 79,4. 84,7. 90,respectively,P < 0. 05). Conclusion The clinical efficacy of Shugan granule in treatment of drug-induced hyperprolactinemia in women patients with first episode schizophrenia is similar to aripiprazole,moreover the side effects and adverse reactions of Shugan granule are significantly less than those of aripiprazole,moreover,the latter has better safety.
引文
1 骆利元,冯斌.抗精神病药物所致高泌乳素血症诊疗现状.山西中医学院学报,2015,6:71-73,76.
2 余云香,吕那,李宇晨,等.抗精神病药物致高泌乳素血症对女性精神病患者卵巢功能的影响.中国医药指南,2016,14:7-8.
3 De HeR M,Detraux J,Peuskens J.Second-generation and newlyapproved antipsychotics,serum prolactin levels and sexualdysfunctions:a critical litemture review.Expert Opin Drug Saf,2014,13:605-624.
4 Capozzi A,Scambia G,LelloS,et al.Hyperprolactinemia:pathophysi-ology and therapeutic approach.Gynecol Endocrinol,2015,31:506-510.
5 汪正华,阚博,周恒.阿立哌唑对抗精神病药物所致高泌乳素血症的影响.皖南医学院学报,2017,42:143-145.
6 Shim JC,Shin JG,Kelly DL,et al.Adjunctive treatment with a dopamine partial agonist aripiprazole for antipsychotic-induced hyperprolactinemia:a placebo-controlled trial.Am J Psychiatry,2007,16:1404-1410.
7 Hasan A,Falkai P,Wobrock T,et al.World federation of societies of biological psychiatry (WFSBP)guidelines for biological treatment of schizophrenia,part 2:update 2012 on the long-term treatment of schizophrenia and management of antipsychotic-induced side effects.World J Biol Psychiatry,2013,14:2-44.
8 许秀峰.单一用药是精神分裂症药物治疗的主流.中华精神科杂志2014,47:177-178.
9 崔桂梅,王萍,李恒芬,等.抗精神病药所致高泌乳素血症的中药治疗.四川中医,2004,22:64-65.
10 王彦国,金萍.高泌乳素血症药物治疗的研究进展.中国老年保健医学,2013,11:65-67.
11 范肖冬,汪向东,于欣等译.ICD-10精神与行为障碍分类.第1版.北京:人民卫生出版社,1993.70-79.
12 何燕玲.阳性和阴性症状量表的中国常模和因子分析.中国临床心理学杂志,2000,8:65.
13 张明园主编.精神科评定量表手册.第1版.长沙:湖南科学技术出版社,1993.146-149.
14 罗雪珍,林金芳.高泌乳素血症对女性的不良影响.实用妇产科志,2016,7:483-484.
15 陶晶,李清伟.抗精神病药物所致高泌乳素血症相关研究进展.中华全科医师杂志,2018,17:329-331.
16 Chen JX,Su YA,Bian QT,et al.Adjunctive aripiprazole in the treatment of risperidone-induced hyperprolactinemia:A randomized,double-blind,placebo-controlled,dose-response study.Psychoneuroen-docrinology,2015,58:130-140.
17 Li XB,Tang YL,Wang C.Adjunctive aripiprazole versus placebofor antipsychotic-induced hyperprolactinemia:meta-analysisofrandomized controlled trials.PLoS One,2013,8:e70179.
18 王学红.丹栀逍遥丸加减泻白散治疗抗精神病药物致高泌乳素血症临床观察.陕西中医,2017,7:833-834.
19 陈芷玲.丹栀逍遥丸加减治疗高泌乳素血症17例.中医学报,2009,8:82-83.
20 齐巧霞,何威,谢乐.丹栀逍遥丸联合维生素B6治疗功能性高泌乳素血症临床研究.实用中医药杂志,2014,11:1021-1022.
2 余云香,吕那,李宇晨,等.抗精神病药物致高泌乳素血症对女性精神病患者卵巢功能的影响.中国医药指南,2016,14:7-8.
3 De HeR M,Detraux J,Peuskens J.Second-generation and newlyapproved antipsychotics,serum prolactin levels and sexualdysfunctions:a critical litemture review.Expert Opin Drug Saf,2014,13:605-624.
4 Capozzi A,Scambia G,LelloS,et al.Hyperprolactinemia:pathophysi-ology and therapeutic approach.Gynecol Endocrinol,2015,31:506-510.
5 汪正华,阚博,周恒.阿立哌唑对抗精神病药物所致高泌乳素血症的影响.皖南医学院学报,2017,42:143-145.
6 Shim JC,Shin JG,Kelly DL,et al.Adjunctive treatment with a dopamine partial agonist aripiprazole for antipsychotic-induced hyperprolactinemia:a placebo-controlled trial.Am J Psychiatry,2007,16:1404-1410.
7 Hasan A,Falkai P,Wobrock T,et al.World federation of societies of biological psychiatry (WFSBP)guidelines for biological treatment of schizophrenia,part 2:update 2012 on the long-term treatment of schizophrenia and management of antipsychotic-induced side effects.World J Biol Psychiatry,2013,14:2-44.
8 许秀峰.单一用药是精神分裂症药物治疗的主流.中华精神科杂志2014,47:177-178.
9 崔桂梅,王萍,李恒芬,等.抗精神病药所致高泌乳素血症的中药治疗.四川中医,2004,22:64-65.
10 王彦国,金萍.高泌乳素血症药物治疗的研究进展.中国老年保健医学,2013,11:65-67.
11 范肖冬,汪向东,于欣等译.ICD-10精神与行为障碍分类.第1版.北京:人民卫生出版社,1993.70-79.
12 何燕玲.阳性和阴性症状量表的中国常模和因子分析.中国临床心理学杂志,2000,8:65.
13 张明园主编.精神科评定量表手册.第1版.长沙:湖南科学技术出版社,1993.146-149.
14 罗雪珍,林金芳.高泌乳素血症对女性的不良影响.实用妇产科志,2016,7:483-484.
15 陶晶,李清伟.抗精神病药物所致高泌乳素血症相关研究进展.中华全科医师杂志,2018,17:329-331.
16 Chen JX,Su YA,Bian QT,et al.Adjunctive aripiprazole in the treatment of risperidone-induced hyperprolactinemia:A randomized,double-blind,placebo-controlled,dose-response study.Psychoneuroen-docrinology,2015,58:130-140.
17 Li XB,Tang YL,Wang C.Adjunctive aripiprazole versus placebofor antipsychotic-induced hyperprolactinemia:meta-analysisofrandomized controlled trials.PLoS One,2013,8:e70179.
18 王学红.丹栀逍遥丸加减泻白散治疗抗精神病药物致高泌乳素血症临床观察.陕西中医,2017,7:833-834.
19 陈芷玲.丹栀逍遥丸加减治疗高泌乳素血症17例.中医学报,2009,8:82-83.
20 齐巧霞,何威,谢乐.丹栀逍遥丸联合维生素B6治疗功能性高泌乳素血症临床研究.实用中医药杂志,2014,11:1021-1022.