鲁拉西酮治疗女性急性期精神分裂症的疗效及代谢风险观察

doi:10.20223/j.cnki.1000-8535.2025.08.019

摘要/Abstract

摘要： 目的比较鲁拉西酮与奥氮平用于治疗女性急性期精神分裂症患者的疗效,以及其对体质量、糖脂代谢风险的影响。以期为女性急性期的精神分裂症患者抗精神病药物的选择提供参考。方法连续选取于2022年4月—2024年4月内江门市第三人民医院收治的女性急性期精神分裂症患者80例,采用计算机随机分组法将患者分为治疗组与阳性药物对照组进行对照。治疗组40例口服鲁拉西酮40~80 mg/d,阳性药物对照40例组口服奥氮平5~20 mg/d。分别测量两组治疗前（基线）以及连续用药治疗2、4、6周后的PANSS量表评分,以及治疗后的代谢指标[体质量指数（BMI）、血清空腹血糖（FPG）、甘油三酯（TG）、总胆固醇（TC）、高密度脂蛋白（HDL）、低密度脂蛋白（LDL）、载脂蛋白A（ApoA）、载脂蛋白B（ApoB）、载脂蛋白E（ApoE）,并将治疗组与对照组前后疗效及各项代谢指标进行比较分析。结果两组的总有效率比较差异无统计学意义（χ²=1.569,P>0.05）;两组治疗前后PANSS量表评分的时间-组别效应与组别效应均无统计学意义（χ²=0.466、3.640,P=0.926、0.056）,时间主效应显著（χ²=363.24,P<0.001）。两组TG、TC、HDL、ApoA、ApoB存在组别-时间交互效应（χ²=7.562、5.991、6.163、6.958、4.397,P=0.006、0.014、0.013、0.008、0.036）,两组TG、ApoA时间主效应显著（χ²=33.473、8.846,P<0.001、0.003）,两组ApoA组别效应显著（χ²=4.889,P=0.027）。结论与奥氮平相比,鲁拉西酮治疗女性急性期精神分裂症的疗效相当,且对代谢指标影响更小。

关键词: 精神分裂症, 鲁拉西酮, 奥氮平, 疗效, 女性, 代谢

Abstract: Objective To compare the efficacy of lurasidone and olanzapine in the treatment of female patients with acute schizophrenia,as well as their effects on body mass,glucose and lipid metabolism risk．To provide reference for the selection of antipsychotic drugs for female patients with acute schizophrenia．Methods From April 2022 to April 2024,80 female patients with acute phase schizophrenia admitted to the Third People's Hospital of Jiangmen City were selected as samples and included in the study． The patients were randomly divided into a treatment group and a positive drug control group using a computer randomization method for comparison．The treatment group took oral lorazepine tablets（40 cases;40-80 mg/d）,while the positive drug control group took oral olanzapine tablets（40 cases;5-20 mg/d）．The Positive and Negative Symptom Scale（PANSS）scores of two groups before treatment（baseline）and after 2,4,and 6 weeks of continuous medication treatment were measured,as well as metabolic indicators after treatment （body mass index[BMI],serum fasting blood glucose[FPG],total cholesterol[TC],triglycerides[TG],high-density lipoprotein[HDL],low-density lipoprotein[LDL],apolipoprotein A[ApoA],apolipoprotein B[ApoB],apolipoprotein E[ApoE]）,and the efficacy and various metabolic indicators between the treatment group and the control group before and after treatment were compared and analyzed．Results The total effective rate of the two groups was not statistically significant（χ²=1.569,P>0.05）．The time-group effect and group effect of PANSS scores before and after treatment in both groups were not statistically significant（χ²=0.466,3.640,P=0.926,0.056）,while the time main effect was significant（χ²=363.24,P<0.001）．There was a group-time interaction effect between two groups of TG,TC,HDL,ApoA,and ApoB（χ²=7.562,5.991,6.163,6.958,4.397,P=0.006,0.014,0.013,0.008,0.036）．The time main effect of TG and ApoA was significant in both groups（χ²=33.473,8.846,P<0.001,0.003）,and the group effect of ApoA was significant in both groups（χ²=4.889,P=0.027）．Conclusions Compared with olanzapine,the efficacy of lurasidone in the treatment of acute phase schizophrenia in women is comparable,and it has a smaller impact on metabolic indicators．

Key words: schizophrenia, lurasidone, olanzapine, therapeutic effect, female sex, metabolism

谈颂桃, 蔡晓燕, 汪媚娟, 刘其贵, 陈善兵, 郑荣华. 鲁拉西酮治疗女性急性期精神分裂症的疗效及代谢风险观察[J]. 广州医药, 2025, 56(8): 1145-1152.

TAN Songtao, CAI Xiaoyan, WANG Meijuan, LIU Qigui, CHEN Shanbing, ZHENG Ronghua. Observation of the efficacy and metabolic risk of lurasidone in the treatment of acute schizophrenia in women[J]. Guangzhou Medical Journal, 2025, 56(8): 1145-1152.

参考文献

[1] KAVEH SAME,PARNIAN SHOBEIRI,et al.A Global,Regional,and National Burden and Quality of Care Index for Schizophrenia:Global Burden of Disease Systematic Analysis 1990-2019[J].Schizophrenia Bulletin,2024,50(5):1083-1093.
[2] CHARLSON F J,FERRARI A J,SANTOMAURO D F,et al.Global epidemiology and burden of schizophrenia:Findings from the global burden of disease study 2016.[J].Schizophr Bull,2018,44(6):1195-1203.
[3] 沈昶邑,张文欣,薛莉莉.医务社会工作参与精神卫生多学科治疗的路径研究[J].现代医院,2024,24(3):438-443,448.
[4] 许秋霞,孙菊水,王世锴,等.棕榈酸帕利哌酮注射液治疗急性期精神分裂症36例[J].医药导报,2015,34(10):1304-1307.
[5] 赵靖平,施慎逊.中国精神分裂症防治指南[M].2版.北京:中华医学电子音像出版社,2015:52-56.
[6] 刘铁桥. 新型抗精神病药的比较[J].国外医学精神病学分册,2000,27(2):75-79.
[7] LOEBEL A,CUCCHIARO J,SILVA R,et al.Efficacy of lurasidone across five symptom dimensions of schizophrenia:Pooled analysis of short-term,placebo-controlled studies[J].Eur Psychiatry,2015,30(1):26-31.
[8] 司天梅,杨建中,舒良,等.阳性和阴性症状量表(PANSS,中文版)的信、效度研究[J].中国心理卫生杂志,2004,18(1):45-47.
[9] 舒良,刘平,周沫.奥氮平治疗精神分裂症的开放性临床验证[J].中华精神科杂志,1999,32(4):223.
[10] 高燕,王彬,翟金国,等.新型非典型抗精神病药鲁拉西酮及其临床应用进展[J].中国临床药理学杂志,2014,30(2):146-148.
[11] 周文竹. 利培酮治疗首发精神分裂症患者血中巢蛋白、微管相关蛋白的变化研究[J].国际医药卫生导报,2020,26(4):475-477.
[12] 钟国坚,黄文华,高建箱,等.家属学校康复模式对精神分裂症患者院外康复的影响[J].现代医院,2021,21(3):456-459.
[13] 胡昕华,顾广中,姜琳.齐拉西酮与利培酮治疗青少年首发精神分裂症的临床效果比较[J].国际医药卫生导报,2021,27(5):753-755.
[14] BARNES T R,DRAKE R,PATON C,et al.Evidence-based guidelines for the pharmacological treatment of schizophrenia:Updated recommendations from the British Association for Psychopharmacology[J].J Psychopharmacol,2020,34(1):3-78.
[15] MEYER J M,LOEBEL A D,SCHWEIZER E.Lurasidone:A new drug in development for schizophrenia[J].Expert Opin Investig Drugs,2009,18(11):1715-1726.
[16] CITROME L,CUCCHIARO J,SARMA K,et al.Long-term safety and tolerability of lurasidone in schizophrenia:A 12-month,double-blind,active-controlled study.[J].Int Clin Psychopharmacol,2012,27(3):165-176.
[17] 陈俊,方贻儒.新型非典型抗精神病药:鲁拉西酮[J].临床精神医学杂志,2022,32(1):81-84.
[18] 陈旭,梁世桥,冯媛,等.鲁拉西酮与利培酮对中国精神分裂症患者催乳素水平影响的比较[J].中国新药与临床杂志,2021,40(12):839-843.
[19] FENG Y,SHI J,WANG L,et al.Randomized, double-blind,6-week non-inferiority study of lurasidone and risperidone for the treatment of schizophrenia[J].Psychiatry Clin Neurosci,2020,74(6):336-343.
[20] 刘树才,陈韶光,王进义.鲁拉西酮和奥氮平对精神分裂症患者疗效及代谢副作用的比较分析[J].福建医药杂志,2023,45(2):56-59.
[21] 汪会霞,赵烨,王胡博,等.非典型抗精神病药物鲁拉西酮及其临床评价[J].世界临床药物,2013,34(6):377-379.
[22] 杨杰,刘海军,李雅忠,等.精神分裂症患者代谢综合征的患病率及相关因素[J].中国健康心理学杂志,2012,20(6):808-809.
[23] 付裕,陈坤玲,李幸.喹硫平联合帕利哌酮治疗精神分裂症疗效及对代谢功能与血清因子的影响[J].广州医药,2024,55(9):1084-1088,1094.
[24] PENNINX B W J H,Depression and cardiovascular disease:Epidemiological evidence on their linking mechanisms[J].Neurosci Biobehav Rev,2017,74(Pt B):277-286.
[25] 颜红英,潘晓华,时云文,等.护理干预对住院精神分裂症伴代谢综合征患者的影响[J].中国民康医学,2015,27(1):108-110.
[26] FERNÁNDEZ GUIJARRO S,POMAROL-CLOTET E,RUBIO MUÑOZ M C,et al.Effectiveness of a community-based nurse-led lifestyle-modification intervention for people with serious mental illness and metabolic syndrome[J].Int J Ment Health Nurs,2019,28(6):1328-1337.