本文選題：阿立哌唑　切入點(diǎn)：利培酮　出處：《蘇州大學(xué)》2013年碩士論文　論文類型：學(xué)位論文

【摘要】：目的：探討阿立哌唑和利培酮對首發(fā)精神分裂癥的療效，社會(huì)功能，代謝相關(guān)指標(biāo)及體重的影響，以期為臨床合理用藥提供依據(jù)。 方法：120例首發(fā)精神分裂癥患者，按照隨機(jī)數(shù)字表法將其隨機(jī)分到阿立哌唑組（研究組，60例）和利培酮組（對照組，60例），分別給予滴定劑量的阿立哌唑口腔崩解片（商品名：博思清；成都大西南制藥股份有限公司生產(chǎn)，治療劑量10-30mg/日）和滴定劑量的利培酮片（商品名：維思通；西安楊森制藥有限公司生產(chǎn)，治療劑量2-6mg/日）。于治療前、治療4、8、24周末分別應(yīng)用陽性與陰性癥狀量表（Positiveand Negative Syndrome Scale，PANSS），個(gè)人和社會(huì)功能量表（personal and socialperformance scale，PSP），副反應(yīng)量表（Treatment Emergent Symptom Scale,TESS）評定療效，社會(huì)功能改善情況及藥物不良反應(yīng)；同時(shí)檢測體重，計(jì)算體重指數(shù)（Body MassIndex，BMI）。于治療前、治療4、8、24周末測定血清代謝相關(guān)指標(biāo)濃度，包括：瘦素（leptin），脂聯(lián)素（Adiponectin），生長激素釋放肽（Ghrelin），胰島素（Insulin）。同時(shí)測定肝、腎功能，血糖，血脂等。采用SPSS17.0統(tǒng)計(jì)軟件，運(yùn)用t檢驗(yàn)、非參數(shù)檢驗(yàn)、卡方檢驗(yàn)、方差分析等對資料進(jìn)行分析。有效率比較用Ridit分析。P＜0.05為有統(tǒng)計(jì)學(xué)意義。 結(jié)果：1.入組時(shí)兩組患者在年齡、性別、病程、家族史等方面相似(P＞0.05)。研究組54例，對照組57例完成本次研究（χ2=1.8018，P=0.1795）。 2.至研究終點(diǎn)，研究組有效率66.7%，對照組有效率68.4%.經(jīng)Ridit分析， R研=0.503， R對=0.488，兩組療效無統(tǒng)計(jì)學(xué)差異（u=0.275，P＞0.05）。 3.兩組的PANSS總分及各因子分在治療4、8、24周末均較治療前有顯著下降(P＜0.01)。研究組治療24周末的PANSS總分及各因子分較治療8周末有顯著下降(P＜0.01)，而對照組僅陽性癥狀分明顯下降（P＜0.05）。治療4、8周末，兩組間PANSS總分及各因子分差異無統(tǒng)計(jì)學(xué)意義（P＞0.05）。治療24周末，研究組的PANSS總分及陰性癥狀、一般精神病理因子分低于對照組評分（P＜0.05)。 4.兩組在治療4、8、24周末的PSP總分顯著高于治療前評分(P＜0.01)；各時(shí)點(diǎn)組間比較差異均無統(tǒng)計(jì)學(xué)意義（P＞0.05）。 5.兩組均未出現(xiàn)嚴(yán)重不良反應(yīng)，，沒有患者因此而終止治療，兩組不良反應(yīng)發(fā)生率相似(P＞0.05)。 6.兩組瘦素濃度在治療4周末較治療前均有明顯增加（P＜0.05)，且持續(xù)至治療24周末（P＜0.05)；治療24周末對照組瘦素濃度增加更明顯（P＜0.05)。 7.研究組脂聯(lián)素濃度在治療8周末較治療前降低（P＜0.01），治療4、24周末脂聯(lián)素濃度與治療前相似（P＞0.05)；對照組治療4周末較治療前降低（P＜0.05），且持續(xù)至24周末（P＜0.05）。 8．研究組Ghrelin濃度在治療8周末較治療前降低（P＜0.01），并持續(xù)至治療24周末（P＜0.01）。對照組Ghrelin各時(shí)點(diǎn)與治療前相似(P＞0.05)。 9.研究組胰島素濃度各時(shí)點(diǎn)與治療前相似(P＞0.05)；而對照組胰島素濃度在治療24周末較治療前增加(P＜0.01)。 10．研究組體重及BMI各個(gè)時(shí)點(diǎn)與治療前相似（P＞0.05)；而對照組治療24周末均較治療前增加(P＜0.05)。 結(jié)論： 1.阿立哌唑和利培酮治療首發(fā)精神分裂癥療效相似，均能有效改善患者社會(huì)功能，為患者回歸社會(huì)提供了可能。 2.阿立哌唑?qū)颊呤菟亍⑸L激素釋放肽濃度的影響更大，但對體重影響不明顯。 3.利培酮對瘦素、脂聯(lián)素、胰島素濃度影響更明顯，可引起體重增加。其引起體重增加的原因也可能與瘦素抵抗（Leptin resistance）及胰島素抵抗（Insulinresistance，IR）有關(guān)。
[Abstract]:Objective: To explore the effect of aripiprazole and risperidone on the first episode schizophrenia, the social function, the metabolism related indexes and body weight, so as to provide evidence for clinical rational drug use.
Methods: 120 patients with schizophrenia were randomly divided into aripiprazole group (60 cases in study group) and risperidone group (control group, 60 cases), were given dose titration of Aripiprazole Orally Disintegrating Tablets (brisking; Southwest Chengdu pharmaceutical Limited by Share Ltd, treatment of 10-30mg/ day) and titrate the dose of Risperidone Tablets (brand Name: Vistone; Xi'an Janssen Pharmaceutical Ltd, dose of 2-6mg/ day). Before treatment, the treatment of 4,8,24 weeks respectively positive and negative symptom scale (Positiveand Negative Syndrome Scale, PANSS), personal and social functioning scale (personal and socialperformance scale, PSP), the reaction volume table (Treatment Emergent Symptom Scale, TESS) to assess the efficacy, social function improvement and adverse drug reaction; at the same time the body weight, body mass index calculation The number of (Body MassIndex, BMI). Before treatment, the treatment of 4,8,24 measured serum indexes of metabolite concentrations, including: leptin (leptin), adiponectin (Adiponectin), growth hormone releasing peptide (Ghrelin), insulin (Insulin). Simultaneous determination of liver, renal function, blood sugar, blood fat and so on. Using SPSS17.0 statistical software using t test, nonparametric test, chi square test and variance analysis are used to analyze the data. The efficiency was compared with Ridit analysis of.P < 0.05 was considered statistically significant.
Results: 1., when entering the group, the two groups were similar in age, sex, course of disease, family history and so on (P > 0.05). 54 cases in the study group and 57 cases in the control group completed the study (chi 2=1.8018, P=0.1795).
From 2. to the end of the study, the effective rate of the study group was 66.7%, and the effective rate of the control group was 68.4%.. After Ridit analysis, R =0.503 and R for =0.488, there was no significant difference between the two groups (u=0.275, P > 0.05).
3. of the two groups of PANSS total score and factor scores of 4,8,24 in the treatment of the weekend was significantly higher than before treatment decreased (P < 0.01). The study group for 24 week PANSS score and each factor score decreased significantly decreased at the end of the 8 week (P < 0.01), while the control group only positive symptom score decreased significantly (P < 0.05). The treatment between the two groups 4,8 weekend, PANSS total score and factor scores were not statistically significant (P > 0.05). After 24 weeks, the study group PANSS total scores and negative symptoms, general psychopathology score score lower than the control group (P < 0.05).
4. the total score of PSP in group 4. was significantly higher than that before treatment (P < 0.01) in the two groups (P < 0.01), and there was no significant difference between each time point group (P > 0.05).
5. the two groups did not have serious adverse reactions, and no patients were terminated, and the incidence of adverse reactions in the two groups was similar (P > 0.05).
6., two groups of leptin concentrations increased significantly at 4 weeks after treatment compared with those before treatment (P < 0.05), and lasted until 24 weeks (P < 0.05). After 24 weeks of treatment, the serum leptin concentration increased more significantly in the control group (P < 0.05).
7., adiponectin concentration in the study group decreased at 8 weeks compared with that before treatment (P < 0.01). The level of adiponectin in treatment group was similar to that before treatment (P < 0.05), while in the control group, the level of adiponectin in the study group was lower than that before treatment (4,24 < 0.01), while that in the control group at 4 weeks was lower than that before treatment (P < 0.05), and lasted for 24 weeks (P < 0.05).
8. the concentration of Ghrelin in the study group decreased at 8 weeks compared with that before treatment (P < 0.01), and lasted until 24 weeks (P < 0.01). The time of Ghrelin in control group was similar to that before treatment (P > 0.05).
9. the time point of insulin concentration in the study group was similar to that before treatment (P > 0.05), while the insulin concentration in the control group was increased at the end of the 24 week treatment (P < 0.01).
10. the time points of body weight and BMI in the study group were similar to those before treatment (P > 0.05), while the control group was increased at the end of 24 weeks than before the treatment (P < 0.05).
Conclusion:
1. aripiprazole and risperidone are similar in the treatment of first episode schizophrenia, which can effectively improve the social function of the patients and provide the possibility for the patients to return to the society.
2. aripiprazole had greater influence on the concentration of leptin and growth hormone releasing peptide (GH) in patients, but the effect on weight was not obvious.
3. risperidone has a more significant effect on leptin, adiponectin and insulin concentration, which can cause weight gain. The cause of weight gain may also be related to leptin resistance (Leptin resistance) and insulin resistance (Insulinresistance, IR).

【學(xué)位授予單位】：蘇州大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2013
【分類號(hào)】：R749.3

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