温亚平 郑克 刘洪杨

[摘要] 目的 探讨齐拉西酮和奥氮平治疗精神分裂症的疗效及对认知功能的影响。 方法 选取住院治疗的精神分裂症患者76例，随机分为观察组与对照组。观察组患者予齐拉西酮片治疗，先予以20 mg/d，2周内逐渐加至维持量80～160 mg/d；对照组患者予以奥氮平片治疗，先予5 mg/d，2周内逐渐加至维持剂量10～20 mg/d。两组疗效均为8周。观察两组患者治疗前与治疗8周后认知功能指标的变化，并比较其临床疗效和安全性。 结果 治疗8周后，两组患者MMSE评分和WMS评分较治疗前明显上升（P<0.05或P<0.01），且观察组患者上升幅度较对照组更明显（P<0.05）；同时观察组患者临床总有效率明显优于对照组（χ2=4.15，P<0.05）；观察组患者TESS评分为（3.47±0.76）分，明显低于对照组的（4.47±0.89）分。两组患者治疗期间血尿常规、肝肾功能及心电图均无明显异常变化。 结论 齐拉西酮和奥氮平治疗精神分裂症能明显改善其认知功能，具有良好的临床效果及安全性，且前者改善认知功能及临床效果更佳，安全性较高。

[关键词] 精神分裂症；齐拉西酮；奥氮平；认知功能

[中图分类号] R749.3 [文献标识码] A [文章编号] 1673-9701（2018）02-0012-04

[Abstract] Objective To investigate the efficacy of ziprasidone and olanzapine in the treatment of schizophrenia and its effect on cognitive function. Methods 76 patients with schizophrenia who were hospitalized in our hospial were randomly divided into observation group and control group. The patients in the observation group were given ziprasidone tablets for 20 mg/d. The dosage was gradually increased to the maintaining dosage of 80-160 mg/d within 2 weeks； the patients in the control group were given olanzapine tablets for 5 mg/d， and the dosage was gradually increased to the maintaining dosage of 10-20 mg/d within 2 weeks. The efficacy was 8 weeks for both groups. The changes of cognitive function in the two groups were observed before treatment and 8 weeks after treatment， and the clinical efficacy and safety were compared. Results After 8 weeks of treatment， the MMSE score and WMS score in the two groups were significantly higher than those before treatment（P<0.05 or P<0.01）， and the increase rate in the observation group was more significant than that in the control group（P<0.05）； the total clinical effective rate in the observation group was significantly better than that in the control group（χ2=4.15， P<0.05）； the TESS score in the observation group was（3.47±0.76）， which was significantly lower than that in the control group（4.47±0.89）. There were not significant changes in blood and urine routine exams， liver and kidney function and ECG during the course of treatment in both groups. Conclusion Ziprasidone and olanzapine in the treatment of schizophrenia can significantly improve its cognitive function， with good clinical efficacy and safety. Ziprasidone has a better efficacy in improving cognitive function and clinical results， with higher safety.

[Key words] Schizophrenia； Ziprasidone； Olanzapine； Cognitive function

精神分裂癥是一种好发于青壮年的精神病，起病较为缓慢或表现为亚急性起病，病程较迁延，病情呈反复发作，并逐渐加重，常出现认知功能障碍，主要表现为记忆、推理、注意、抽象及执行等方面的功能障碍[1，2]。以往对精神分裂症的研究与治疗侧重于抗精神病药物改善患者阳性与阴性症状方面，而对其认知功能障碍的研究较少，近年来对精神分裂症认知功能的治疗及预后改善问题已引起人们的广泛关注[3-5]。齐拉西酮和奥氮平均为治疗精神分裂症常用药物，两者均能明显改善患者的阳性、阴性症状，但其对认知功能的影响国内外报道较少[6，7]。本研究观察齐拉西酮与奥氮平治疗精神分裂症的疗效、安全性及对认知功能的影响，现报道如下。

1 资料与方法

1.1 一般资料

选取2015年1月～2016年4月我院住院诊治的76例精神分裂症患者。……