| 王建锋,刘邦文,张艳艳,薛艳萍,郭亮,吴延海.阿立哌唑与利培酮对慢性精神分裂症患者症状改善的效果比较[J].四川精神卫生杂志,2025,(2):108-114.Wang Jianfeng,Liu Bangwen,Zhang Yanyan,Xue Yanping,Guo Liang,Wu Yanhai,Comparision of aripiprazole and risperidone in improving psychiatric symptoms among chronic schizophrenia patients[J].SICHUAN MENTAL HEALTH,2025,(2):108-114 |
| 阿立哌唑与利培酮对慢性精神分裂症患者症状改善的效果比较 |
| Comparision of aripiprazole and risperidone in improving psychiatric symptoms among chronic schizophrenia patients |
| 投稿时间：2024-08-02 |
| DOI：10.11886/scjsws20240802003 |
| 中文关键词: 慢性精神分裂症 阿哌利唑 利培酮 前脉冲抑制 症状改善 |
| 英文关键词:Chronic schizophrenia Aripiprazole Risperidone Prepulse inhibition Symptom improvement |
| 基金项目:2021年度阜阳市卫生健康委科研课题（项目名称：精神分裂症伴代谢障碍的认知功能研究，项目编号：FY2021-147） |
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| 中文摘要: |
| 背景 非典型抗精神病药物在慢性精神分裂症患者中应用广泛，常用药物包括阿立哌唑、利培酮等，但两种药物作用机制有所差异，既往研究从多角度分析两种药物对慢性精神分裂症患者症状改善效果的可信性证据不足。目的 探讨阿立哌唑和利培酮对慢性精神分裂症患者症状改善的效果以及对患者前脉冲抑制（PPI）、认知功能及神经营养因子水平的影响，为优化慢性精神分裂症的药物治疗方案提供参考。方法 选取2021年3月—2023年3月阜阳市第三人民医院收治的、符合《国际疾病分类（第10版）》（ICD-10）慢性精神分裂症诊断标准的86例患者为研究对象，采用随机数字表法分为阿立哌唑组和利培酮组各43例。阿立哌唑起始剂量5 mg/次、1次/日，一周后逐渐加量，最高25 mg/次、1次/日。利培酮组起始剂量0.5 mg/次、2次/日，一周后逐渐加量，最高3 mg/次、2次/日。两组均治疗3个月。于治疗前和治疗3个月后，采用阳性和阴性症状量表（PANSS）、强弱刺激结合的被动注意PPI检测范式以及威斯康星卡片分类测验（WCST）进行评定，并检测神经营养因子水平。记录两组不良反应发生情况。将治疗前PANSS评分、PPI、WCST、神经营养因子水平作为协变量，采用协方差分析比较两组治疗后PANSS评分、PPI、WCST及神经营养因子水平的差异。结果 治疗3个月后，两组PANSS一般精神病理分量表、阳性症状分量表、阴性症状分量表评分及总评分比较，差异均无统计学意义（F=0.621、0.815、0.743、0.752，P均>0.05），两组PPI抑制率、单独强刺激波幅、单独强刺激潜伏期、强弱刺激波幅、强弱刺激潜伏期比较，差异均无统计学意义（F=0.174、0.001、0.183、0.171、0.001，P均>0.05），两组WCST总测验次数比较，差异无统计学意义（F=0.512，P>0.05），阿立哌唑组WCST完成分类数和正确次数均高于利培酮组，随机错误数和持续错误数均低于利培酮组，差异均有统计学意义（F=3.737、4.621、4.892、5.130，P均<0.05）。阿立哌唑组脑源性神经因子（BDNF）和神经生长因子（NGF）水平均高于利培酮组，胶质纤维酸性蛋白因子（GFAP）水平低于利培酮组，差异均有统计学意义（F=4.414、3.781、6.319，P<0.05或0.01）。两组不良反应发生率比较，差异无统计学意义（χ2=0.261，P>0.05）。结论 阿立哌唑可能更有助于改善慢性精神分裂症患者的认知功能与神经营养因子水平。 |
| 英文摘要: |
| Background Atypical antipsychotics have been widely used in patients with chronic schizophrenia， and aripiprazole and risperidone are the most commonly used drugs. The mechanism of action of the two is different， while previous studies have provided insufficient credible evidence from multiple perspectives to support the comparative efficacy of the two drugs in improving symptoms in patients with chronic schizophrenia.Objective To compare the efficacy of aripiprazole and risperidone on the improvement of symptoms， prepulse inhibition （PPI）， cognitive functioning and neurotrophic factors in patients with chronic schizophrenia， so as to provide effective treatment regimens for these patients.Methods A total of 86 patients with chronic schizophrenia attending the psychiatry department of the Third People's Hospital of Fuyang from March 2021 to March 2023 and fulfilling the diagnostic criteria of International Classification of Diseases， tenth edition （ICD-10） were enrolled and grouped using random number table method， each with 43 cases. Aripiprazole group was given oral aripiprazole once daily at an initial dose of 5 mg for one week and then gradually increased to a maximum dose of 25 mg. Risperidone group received oral risperidone twice daily at an initial dose of 0.5 mg for one week and then gradually increased to a maximum dose of 3 mg. Treatment in both groups lasted 3 months. Before treatment and 3 months after treatment， Patients were required to complete Positive and Negative Symptom Scale （PANSS）， detection of both strong and weak PPIs in a startle modification passive attention paradigm， Wisconsin Card Sorting Test （WCST） and the measurement of neurotrophic factors at baseline and after treatment. The adverse reactions were recorded. Analysis of covariance was used to test the difference between the PANSS score， PPI， WCST and neurotrophic factor levels of the groups， with the pretest used as the covariate.Results 3 months after treatment， no statistical difference was found in the scores of PANSS general psychopathology subscale， positive symptom subscale， negative symptom subscale and total score between two groups after treatment （F=0.621， 0.815， 0.743， 0.752， P>0.05）. There were no statistically significant differences between the two groups in PPI inhibition rate， single intense stimulus amplitude， single intense stimulus latency， prepulse inhibition amplitude， or prepulse inhibition latency （F=0.174， 0.001， 0.183， 0.171， 0.001， P>0.05）. There was no statistically significant difference in the total number of WCST tests between two groups （F=0.512， P>0.05）， whereas aripiprazole group reported significantly larger total numbers of categories completed and correct responses as well as smaller total numbers of random errors and perseverative errors compared to risperidone group （F=3.737， 4.621， 4.892， 5.130， P<0.05）. A significant increase in brain-derived neurotrophic factor （BDNF） and nerve growth factor （NGF） along with a reduction in glial fibrillary acidic protein （GFAP） were documented in risperidone group when compared to risperidone group （F=4.414， 3.781， 6.319， P<0.05）. No significant difference was demonstrated in the incidence of adverse reactions between the two groups （χ2=0.261， P>0.05）.Conclusion Aripiprazole may be more beneficial than risperidone in improving cognitive functioning and neurotrophic factor levels in patients with chronic schizophrenia. ［Funded by Scientific Research Project of Fuyang Municipal Health Commission in 2021 （number， FY2021-147）］ |
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