利培酮和氯氮平治疗儿童少年精神分裂症患者疗效与安全性比较

目的评价氯氮平和利培酮治疗儿童少年精神分裂症的疗效和安全性。方法145例儿童少年精神分裂症患者被随机分为氯氮平组（73例）和利培酮组（72例），住院治疗8周，用阳性与阴性症状量表（PANSS）和临床疗效总评量表（CGI）评定临床疗效，用副反应量表（TESS）评价安全性。结果在治疗4周和8周末，氯氮组患者阳性因子减分率均显著高于利培酮组（t=2．828，3．381，P〈0．01），其它因子分及PANSS总分减分率两组患者比较均无显著差异（P〉0．05）；CGI疗效评定标准比较显示，氯氮平治疗效果优于利培酮（Ridit分析，μ=2．425，2．223，P〈0．05）。利培酮治疗无效的患者换用氯氮平治疗后50％有效，氯氮平治疗无效的患者换用利培酮治疗后20％有效。氯氮平的不良反应主要有心动过速、心电图异常、白细胞下降、嗜睡、流涎、尿失控、头昏和癫痫发作，利培酮的不良反应主要有急性锥体外系反应和嗜睡；氯氮平组有9．6％的患者、利培酮组有2．8％的患者因不能耐受副反应退出治疗。结论氯氮平和利培酮均是有效的治疗儿童精神分裂症的药物，氯氮平的治疗效果、特别在改善阳性症状方面优于利培酮，但利培酮较氯氮平副作用少，安全性高。

A Controlled Study of Clozapine and Risperide in the Treatment of Children with Schizophrenia

Objective To evaluate the therapeutic and side effects of Clozapine and Risperide in the treatment of children with schizophrenia. Methods 145 patients with first episode childhood schizophrenia were assigned into Clozapine group （n=73） and Risperide group （n=72） by random allocation. The effects of treatment were evaluated with Positive and Negative Syndrome Scale （PANSS） and Clinical Global Impression （CGI）. The side effects were evaluated with Treatment Emergent Symptom Scale （TESS）. Results At the end of 4th and 8th week, decrease rate of scores for positive symptom was higher in Clozapine group then in Risperide group （t=2. 828, 3. 381, P〈0.01）. By CGI assessment criterion, Clozapine was more effective than Risperide （Ridit analysis μ= 2. 425, 2. 223, P〈0.05）. 50% of treatment-resistant patients to Risperide are effective by using Clozapine. 20% of treatment-resistant patients to clozapine are effective by using Risperide. The side effects of Clozapine include mainly tachycardia, abnormal cardiogram, white blood cell decreasing, hypersomnia, hypersalivation, urinary incontinence, faint and epileptic seizures. The side effects of Risperide include mainly extrapyramidal symtoms and hypersomnia. 9.6% of patients treated with Clozapine and 2.8 % with Risperide retreated from treatment because of the serious side effects result of medicine. Conclusion Both Clozapine and Risperide are effective in treating childhood schizophrenia. Clozapine is more effective than Risperide especially in treatment of positive symptom. But Risperide is less side effect and provides more safety than Clozapine.