【摘要】 目的:探讨难治性精神分裂症(treatment resistant schizophrenia, TRS)的优化治疗方案。方法:52例TRS患者随机分为氯氮平单药治疗组(n=20)、氯氮平与利培酮联合治疗组(n=16)、氯氮平与阿立哌唑联合治疗组(n=16)。分别在治疗4周、8周时应用阳性与阴性症状量表、阴性症状量表、精神病症状维度评定量表评定3组疗效，并监测糖脂代谢水平，如血脂、空腹血糖、体质量指数(BMI)变化及不良反应发生率。结果:各组治疗4周及8周时有效率差异无统计学意义(P>0.05)。治疗后，各组低密度脂蛋白、空腹血糖、BMI的变化差异无统计学意义(P均>0.05)。各组不良反应发生率差异无统计学意义(P>0.05)。结论:氯氮平联合利培酮或阿立哌唑治疗TRS患者未观察到增效作用，同时联合用药并未增加或降低药物不良反应率及代谢综合征的风险。更多还原

【Abstract】 Objective: To investigate an optimal treatment for treatment-resistant schizophrenia(TRS). Method:52 TRS patients were randomly assigned to clozapine monotherapy group(n=20),risperidone with clozapine group(n=16) and aripiprazole with clozapine group(n=16).Positive and Negative Syndrome Scale(PANSS),Scale for the Assessment of Negative Symptoms(SANS),Clinician-Rated Dimensions of Psychosis Symptom Severity(CRDPS) were used to assess the treatment effects, and the metabolic indexes including blood lipid, fasting blood-glucose and body mass index(BMI) and the rate of adverse effects at baseline were monitored after the treatment of 4 and 8 weeks. Results:The response rates showed no significant difference in 4 weeks and 8 weeks after treatment among the three groups(P>0.05).There were no statistically significant differences in low density lipoprotein, fasting blood-glucose, and BMI after the treatment(all P>0.05).Adverse effects were also not significantly different among the three groups(P>0.05). Conclusion:Clozapine combined risperidone or aripiprazole is not the effective optimal treatment in the TRS patients, and the augmentation strategies of antipsychotics don’t increase or reduce the risk of adverse effects or metabolic syndrome.更多还原