【摘要】 目的评价和比较首发精神分裂症患者应用第一代抗精神病药物与第二代抗精神病药物对认知功能的影响及疗效和不良反应。方法选取102例首发精神分裂症患者,随机分为三组,第一组给予氨磺必利片(氨磺必利组),第二组给予氯丙嗪片(氯丙嗪组),第三组给予氟哌啶醇片(氟哌啶醇组),分别于治疗前及治疗后第8、12周末评测威斯康星卡片测试(WCST)、韦氏成人智力量表(WAIS-RC),于治疗前及治疗后第12周末评测阳性和阴性综合征量表(PANSS),治疗后第8、12周末评测治疗中需处理的不良反应症状量表(TESS),进行认知功能的影响比较及疗效和不良反应评价。结果三组治疗后第8、12周末WCST分类数(CC)、错误应答数(RE)、持续应答数(RP)、持续错误数(RPE)、非持续错误数(NPE)、完成第一类所需应答数(TCC)比较差异均有统计学意义(P <0. 05)。治疗后第8、12周末氨磺必利组WCST中RE、RP、RPE、NPE、TCC均较治疗前降低(P <0. 05),CC较治疗前升高(P <0. 05)。三组治疗后第8、12周末WAIS-RC智商总分、言语分、操作分比较差异均有统计学意义(P <0. 01)。治疗后第8、12周末氨磺必利组WAIS-RC智商总分、言语分、操作分均较治疗前升高(P <0. 05)。三组治疗后第12周末PANSS总分及阴性症状评分、一般病理症状评分比较差异有统计学意义(P <0. 01)。治疗后第12周末氨磺必利组PANSS总分及各因子分均较治疗前降低(P <0. 05),氯丙嗪组和氟哌啶醇组PANSS总分及阳性症状、一般病理评分较治疗前降低(P <0. 05)。三组治疗后第8、12周末TESS行为毒性、神经系统、植物神经、心血管系统评分比较差异有统计学意义(P <0. 01)。治疗后第12周末氯丙嗪组和氟哌啶醇组TESS神经系统、植物神经、心血管系统评分均较治疗后第8周末降低(P <0. 05)。结论首发精神分裂症患者在应用第二代抗精神病药物治疗后,认知功能改善优于第一代抗精神病药物,对阳性症状的控制与第一代抗精神病药物相当,对阴性症状的改善优于第一代抗精神病药物,不良反应与第一代抗精神病药物相比较少。更多还原

【Abstract】 Objective To evaluate and compare the effects,efficacy and adverse reactions on cognitive function in patients with first-episode schizophrenia using first generation antipsychotics（ FGA） and second generation antipsychotics（ SGA）.Methods A total of 102 patients with first-episode schizophrenia were selected and randomly divided into amisulpride group treated with amisulpride,chlorpromazine group treated with chlorpromazine,haloperidol group treated with haloperidol for 12 weeks. They were assessed with Wisconsin Card Sorting Test（ WCST）,Wechsler Adult Intelligence Scale-Revised China（ WAIS-RC） before treatment and at the 8^th,12^th weekends after treatment,Positive and Negative Syndrome Scale before treatment and at the 12^th weekend after treatment,Treatment Emergent Symptoms Scale（ TESS） at the 8^th,12^th weekends after treatment to compare the cognitive function and evaluate efficacy and adverse reactions. Results There existed significant differences in CC,RE,RP,RPE,NPE and TCC of WCST among three groups at the 8^th and 12^th weekends after treatment（ P <0. 05）. In amisulpride group at the 8^th,12^th weekends after treatment,RE,RP,RPE,NPE and TCC of WCST decreased significantly compared with those before treatment（ P < 0. 05）,and CC increased significantly compared with those before treatment（ P < 0. 05）. There existed significant differences in factor scores of IQ,speech and operation of WAIS-RC among three groups at the 8^th and 12^th weekends after treatment（ P < 0. 01）. In amisulpride group at the 8^th,12^th weekends after treatment,factor scores of IQ,speech and operation of WAIS-RC increased significantly compared with those before treatment（ P < 0. 05）.There existed significant differences in the total score and factor scores of negative symptoms,general psychopathology of PANSS among three groups at the 12^th weekend after treatment（ P < 0. 01）. At the 12^th weekend after treatment,the total score and all factor scores of PANSS in amisulpride group decreased significantly compared with those before treatment（ P < 0. 05）; the total score and factor scores of positive symptom,general psychopathology of PANSS in chlorpromazine group and haloperidol group decreased significantly compared with those before treatment（ P < 0. 05）. There existed significant differences in factor scores of behavioral toxicity,nervous system,vegetative nerve and cardiovascular system of TESS among three groups at the 8^th and 12^th weekends after treatment（ P < 0. 01）. At the 12^th weekend after treatment,the factor scores of nervous system,vegetative nerve and cardiovascular system of TESS in chlorpromazine group and haloperidol group decreased significantly compared with those at the 8^th weekend after treatment（ P < 0. 05）. Conclusion Compared with the patients with first-episode schizophrenia using FGA,patients with first-episode schizophrenia using SGA get better improvements in cognitive function and negative symptoms with less adverse reactions,and relatively same efficacy in positive symptoms.更多还原