【摘要】 目的比较奥氮平与利培酮治疗阿尔茨海默病(AD)临床效果及对血清β-淀粉样蛋白(Aβ)、脑源性神经营养因子(BDNF)水平的调节作用。方法选择新乡市中心医院2018年3月至2020年2月诊治的158例阿尔茨海默病患者作为研究对象,按随机数表法分为奥氮平组和利培酮组,各79例,前者接受奥氮平联合茴拉西坦治疗,后者接受利培酮联合茴拉西坦治疗。采用痴呆病理行为评定量表(BEHAve-AD)和阳性与阴性症状量表(PANSS)评估精神行为症状,简易精神状态评价量表(MMSE)评估认知功能,并检测血清超氧化物歧化酶(SOD)、丙二醛(MDA)、Aβ和BDNF水平。根据BEHAve-AD量表的减分率评估疗效,药物副反应量表(TESS)评估安全性。结果两组患者治疗有效率比较,差异无统计学意义(P>0.05);两组患者治疗后BEHAve-AD评分和PANSS评分较治疗前均降低(P<0.05),但两组组间比较,差异无统计学意义(P>0.05);两组患者治疗后认知功能各项评分之间比较,差异无统计学意义(P>0.05);治疗前两组患者血清SOD、MDA、BDNF和Aβ水平比较,差异无统计学意义(P>0.05),治疗后奥氮平组血清SOD和BDNF水平高于利培酮组,MDA和Aβ水平低于利培酮组(P<0.05);奥氮平组患者锥体外系反应和失眠发生率低于利培酮组(P<0.05),其余不良反应发生率比较,差异无统计学意义(P>0.05)。结论奥氮平与利培酮分别联合茴拉西坦治疗AD患者均可改善其精神行为症状和认知功能,疗效相当,但奥氮平对血清SOD、MDA、BDNF和Aβ水平改善程度更大,且安全性更高。更多还原

【Abstract】 Objective To compare the clinical effects of olanzapine and risperidone in the treatment of Alzheimer’s disease(AD) and regulating effect on serum β-amyloid protein(Aβ) and brain-derived neurotrophic factor(BDNF) levels.Methods From March 2018 to February 2020, 158 patients with AD were selected and divided into olanzapine group and risperidone group by random number table method with 79 cases in each group. The former was treated with olanzapine combined and aniracetam. The latter was treated with risperidone combined and aniracetam. The dementia pathological behavior rating scale(BEHAve-AD) and the positive and negative syndrome scale(PANSS) were used to assess mental and behavioral symptoms, and the mini-mental state examination(MMSE) was used to assess cognitive function. The levels of serum superoxide dismutase(SOD), malonaldehyde(MDA), Aβ and BDNF were tested. The curative effect was evaluated according to the reduction rate of the BEHAve-AD, and the safety was evaluated with the treatment emergent symptom scale(TESS).Results There was no statistically significant difference in response rate between the two groups(P>0.05). After treatment, BEHAve-AD and PANSS scores of both groups were lower than those before treatment(P<0.05). However, there was no significant difference between the two groups(P>0.05). There was no statistically significant difference in cognitive function scores between the two groups after treatment(P>0.05). There were no statistically significant differences in serum SOD, MDA, Aβ and BDNF levels between the two groups before treatment(P>0.05). After treatment, serum SOD and BDNF levels of olanzapine group were higher, while serum MDA and Aβ levels were lower than those in risperidone group(P<0.05). The incidences of extrapyramidal reactions and incidence of insomnia in olanzapine group were lower than those in risperidone group(P<0.05). But there was no statistically difference in the incidence of other adverse reactions(P>0.05).Conclusion Both olanzapine and risperidone respectively combined with aniracetam can improve mental behavioral symptoms and cognitive function in patients with AD with equivalent curative effects. However, olanzapine can significantly improve serum SOD, MDA, Aβ and BDNF levels, and it is safer.更多还原