新型抗精神病药对血糖水平影响的比较研究

目的　比较几种新型抗精神病药对血糖水平的影响。方法　前瞻性调查使用新型抗精神病药治疗的住院精神病人 ,观察血糖变化 ,并分析影响血糖水平的相关因素 (年龄、病程、药物种类、药物剂量等 )。结果　在 12 0例住院精神病人中 ,氯氮平、奥氮平、利培酮和奎的平 4种抗精神病药引起糖代谢异常的机率有显著性差异 (P <0 .0 5 )。年龄越大引起糖代谢异常的机率越高 (P <0 .0 5 )。结论　氯氮平、奥氮平比利培酮、奎的平引起糖代谢异常的发生率高 ,奎的平最低 ,应引起临床关注     

利培酮、氯氮平与氯丙嗪的疗效和不良反应及相关因素的研究

目的　比较利培酮、氯氮平与氯丙嗪的疗效和不良反应 ,探讨有关的实验室检查和药物浓度相互关系。方法　将符合CCMD 2 R诊断标准的精神分裂症患者 ,根据临床情况和入院顺序 ,分别进入利培酮组、氯氮平组与氯丙嗪组 ,观察 8周。以PANSS、CGI、TESS和ESRS量表评定药物的疗效和不良反应。同时测定血清泌乳素和药物浓度。结果　治疗 8周后 :①利培酮组、氯氮平线和氯丙嗪组的PANSS量表总分、阴性分量表、一般精神病理学分量表和CGI量表病情严重程度评分均下降 ,而利培酮组和氯氮平组减分较氯丙嗪组明显 (分别P <0 0 1,P <0 0 5 ) ,TESS及ESRS量表的评分也与氯丙嗪组有显著性差异 (分别为P <0 0 1,P <0 0 5 )。②利培酮组、氯氮平组与氯丙嗪组肝功能、心电图检查组间差异有非常显著意义 (均P <0 0 1)。③氯氮平的剂量与去甲氯氮平、氯氮平浓度呈显著相关 ,9 羟利培酮浓度与PRL、利培酮有效率呈显著性相关 ,氯丙嗪浓度与PRL呈显著性相关 (rs=0 .2 6 1,P =0 .0 15 )。结论　利培酮、氯氮平具有较强抗精神病作用 ,相对氯丙嗪更为有效和全面。利培酮的安全性相对较好。     

氯氮平和利培酮对首发精神分裂症患者糖代谢影响的研究

目的　探讨氯氮平和利培酮对首发精神分裂症患者糖代谢的影响。方法　 6 8例首发精神分裂症患者随机分为两组 ,分别给予氯氮平治疗 ( 34例 ,氯氮平组 )和利培酮治疗 ( 34例 ,利培酮组 )。两组患者治疗前和治疗后第 4周末做糖耐量试验 ,测定空腹胰岛素、C肽、甘油三酯、胆固醇、瘦素 ,并测量身高、体重 ,计算体重指数 [BMI,体重 (kg) /身高 (m2 ) ]。共观察 4周。结果　治疗第 4周末 ,氯氮平组餐后 1h、2h的血糖值 [分别为 ( 8 6± 1 8)mmol/L和 ( 6 7± 1 1)mmol/L]比治疗前 [分别为( 7 4± 2 2 )mmol/L和 ( 5 8± 1 4 )mmol/L]明显升高 (P <0 0 5 ,P <0 0 1) ,而利培酮组无明显变化。治疗后氯氮平组 ( 2 0 % ,7例 )患者糖耐量减低的发生率高于利培酮组 ( 3% ,1例 ) ,差异有显著性 ( χ2 =3 972 ,P <0 0 5 )。结论　氯氮平对首发精神分裂症患者餐后血糖值的影响大于利培酮     

抗精神病药物对精神分裂症患者血脂、血糖和体重影响的研究

目的比较精神分裂症患者服用抗精神病药物后血脂、血糖及体重的变化,评价不同药物的安全性。方法选择109例单一应用抗精神病药物治疗满8周的精神分裂症患者,分别于第4周、第8周测量血脂(胆固醇、甘油三脂)、血糖和体重。结果服用抗精神病药物后女性、高龄患者甘油三脂增高显著,差异有统计学意义(t=-2.34,P<0.05;r=0.256,P=0.007);氯氮平对胆固醇升高影响显著高于利培酮、奎硫平、氯丙嗪、奋乃静等(P<0.05);氯氮平、氯丙嗪对甘油三脂升高影响显著高于利培酮(P<0·05);所有纳入研究的药物对血糖、体重有不同程度影响,差异无显著性(P>0.05)。结论大多数抗精神病药物可增加高血脂、肥胖的风险,选择药物应考虑性别及年龄因素。     

住院精神分裂症并发糖尿病患者与抗精神病药物应用的关系分析

目的探索抗精神病药物与精神分裂症伴发糖尿病的临床关系。方法观察445例住院精神分裂症患，将氯丙嗪、氯氮平、利培酮及氯氮平合并氯丙嗪分组比较，研究药物种类、住院治疗时间对血糖的影响程度。结果血糖增高和糖尿病的发生率分别为19．78％和12．13％，都以氯氮平合并氯丙嗪组最高，氯氮平次之；氯丙嗪组、氯氮平组及氯氮平合并氯丙嗪组末次血糖浓度明显高于首次血糖浓度。除利培酮组外，住院治疗1～10年的血糖浓度明显增高，但10年后氯氮平组仍有增高趋势。结论氯氮平合并氯丙嗪对血糖代谢影响最大，氯氮平具有更长远的不利影响，使用抗精神病药物时应定期监测血糖。     

利培酮、氯氮平和氟哌啶醇治疗精神分裂症的疗效比较结果

目的　比较利培酮、氯氮平和氟哌啶醇的疗效和不良反应。方法　将符合CCMD - 2 -R诊断标准的精神分裂症患者 ,根据入院顺序分别进入利培酮组、氯氮平组和氟哌啶醇组 ,并观察 8周。以PANSS和TESS量表评定药物的疗效和不良反应。结果　利培酮组、氯氮平组和氟哌啶醇组的PANSS量表总分、阴性分量表、一般精神病理学分量表评分均下降 ;利培酮组和氯氮平组减分较氟哌啶醇组明显 (分别P <0 0 1,P <0 0 5 ) ,TESS量表的评分也与氟哌啶醇组有显著性差异 (分别P <0 0 1,P <0 0 5 ) ;利培酮组、氯氮平组和氟哌啶醇组肝功能、心电图检查结果 ,组间差异有非常显著意义 (P <0 0 1) ;利培酮组不良反应少于氯氮平组和氟哌啶醇组。结论　利培酮、氯氮平和氟哌啶醇均具有较强的抗精神病作用 ,利培酮的安全性相对较好。     

氯氮平与利培酮对精神分裂症患者血糖的影响

目的　探讨氯氮平与利培酮对精神分裂症患者血糖的影响。方法　对 6 0例精神分裂症患者分为氯氮平组和利培酮组 ,进行为期 8周的治疗 ,采用自身对照 ,比较用药前后血糖浓度。结果　氯氮平组治疗后血糖浓度显著升高 (P <0 .0 5 ) ;利培酮组治疗后血糖无明显变化 (P >0 .0 5 )。结论　氯氮平可引起精神分裂症患者血糖升高 ;利培酮则无明显影响     

氯丙嗪、氯氮平、利培酮对血糖影响的对照分析

目的　比较氯丙嗪、氯氮平及利培酮对精神分裂症病人血糖的影响。方法　采用全自动生化仪对单用氯丙嗪、氯氮平或利培酮治疗的精神分裂症病人各 3 0例进行治疗前后的血糖测定对比分析。结果　氯氮平组的精神分裂症病人治疗后血糖较治疗前明显升高 (P <0 0 1) ,氯丙嗪组和利培酮组治疗前后血糖无明显变化 (P >0 0 5 )。结论　氯氮平可引起精神分裂症病人糖代谢的异常 ,在用氯氮平时应注意监测血糖。     

利培酮治疗儿童精神分裂症临床对照研究

有报道氯氮平治疗儿童精神分裂症疗效确定 [1 ] ,我们以氯氮平为对照观察利培酮对儿童精神分裂症的疗效与副反应 ,报告如下。1　对象与方法于 1997年 4月～ 2 0 0 0年 10月在我院住院 ,发病年龄小于 14岁的患者 ,符合 CCMD- 2 - R精神分裂症诊断标准 ,年龄 12～ 18岁 ,病程 3个月～ 5年 ,入院时简明精神病评定量表 ( BPRS)≥ 4 0分。共 4 0例 ,将病人随机平分为 2组 ;利培酮组及氯氮平组各 2 0例。两组平均年龄与病程差异均无显著性 ( P均 >0 .0 5 )。入组时停药清洗 1周。利培酮剂量最大 5 mg/d,氯氮平4 5 0 mg/d。疗程 8周。治疗中可…     

抗精神病药物对嗜酸性粒细胞的影响

目的探讨几种抗精神病药物对精神分裂症患者嗜酸性粒细胞的影响。方法随机选取抗精神病药物治疗精神分裂症患者300例,分别在治疗前及治疗后每周测定血细胞计数与分类。结果患者经利培酮、氯氮平和氯丙嗪治疗后嗜酸性粒细胞增多有的60例(20%)。氯氮平组发生率(29.1%)显著高于利培酮组(14%)(P<0.01),氯丙嗪组与利培酮组无明显差异(P>0.05)。结论典型和非典型抗精神病药物对嗜酸性粒细胞均有影响,可能与免疫系统有关。     

Mechanisms of the suppression of the nociceptive reflex of the opening of the mouth during stimulation of the structures of the limbic brain

The comparative effectiveness of the inhibitory influence of tetanic stimulation of hypothalamus, amygdala and limbic cortex on EMG-response of m. digastricus evoked by electrical stimulation of tooth pulp nociceptive afferents was studied in cats anesthetized with a mixture of chloralose and nembutal. It was found that inhibition of the EMG-component of the jaw-opening reflex is most pronounced in case of stimulation of medial and lateral region of the hypothalamus, the inhibitory effect of central and medial nuclei of the amygdala is less pronounced and the effect of the limbic cortex is the weakest. It was shown that the mechanism of the antinociceptive effect of tetanic stimulation of the hypothalamus is not related to the concomitant increase of the blood pressure. After stabilization of the blood pressure the suppressive effect of the hypothalamus remains without changes, that points out to a direct, primary, not baro-afferent mechanism of the inhibition of the activity of nociceptive neurons of the trigeminal sensory nuclei. Noradrenaline, injected intravenously, induced a large increase of the blood pressure accompanied by a pronounced inhibition of the pain reflex. Angiotensin causes the same degree of blood pressure elevation without changes in the amplitude of the EMG-response of the pain reflex. Hypothalamic and noradrenergic mechanisms for control of pain sensitivity are discussed.     

药物治疗与合并认知行为治疗对强迫症疗效的比较

目的探讨认知行为心理治疗(CBT)在强迫症(OCD)患者各亚型治疗中的有效性和规律性。方法本研究为临床对照研究。符合入组标准的强迫症患者按患者自愿原则分为两组,治疗观察3、6、12个月。疗效评定分别运用Yale-Brown强迫量表,自拟的自评好转程度量表和临床疗效评定。结果认知行为心理治疗合并药物治疗组31例,临床有效率70.9%,其中治愈率1.8%。单纯药物治疗组24例,临床有效率33.3%。Yale-Brown强迫量表和自评量表得分在6个月和12个月两组有显著差异(P<0.05)。其中强迫症亚型(怕脏型、反复检查型和反复担心型)的疗效比较,怕脏型在治疗3个月末两组间自评量表评分有显著性差异(P<0.05);反复担心型在治疗6个月末两组间Yale-Brown强迫量表总分有显著性差异(P<0.05);反复检查型两组间无统计学差异。结论认知行为心理治疗合并药物治疗强迫症的疗效明显优于单纯药物治疗。强迫症的亚型在治疗中的有效性次序为:反复担心型>怕脏型>反复检查型。     

Characteristics of the sympathetic innervation of the nictitating membrane and of the vasculature of the nose and tongue of the cat

Summary Vasomotor responses from the nasal mucosa and tongue, and contractions of the nictitating membrane, were recorded on stimulation of the cervical sympathetic or internal carotid nerves.Preganglionic sympathetic nerve fibres which elicited a membrane response possessed a lower threshold than those which evoked nasal vasoconstriction, while the latter displayed a lower threshold than fibres which evoked tongue vasoconstriction. The sympathetic vasodilator fibres to the tongue, whose activity was revealed after-receptor blockade, had a similar threshold to the vasoconstrictor fibres.Membrane contraction, nasal vasoconstriction and occasionally tongue vasoconstriction could be evoked by stimulating the internal carotid nerve. The postganglionic fibres innervating the nasal mucosa had a similar threshold to those of the nictitating membrane, which may indicate that there are small myelinated fibres innervating the mucosa.The preganglionic compound nerve action potential had four major components, S₁–S₄. S₁, S₂ and usually S₃ fibres were associated with membrane contraction; S₂, S₃ and sometimes S₁ fibres were associated with nasal vasoconstriction; and S₃, usually S₂ and occasionally S₁ fibres were associated with vasoconstriction in the tongue. It is concluded that each of these three groups of nerve fibres, but not S₄ fibres, may include fibres associated functionally with the three effectors.There was a considerable difference between the relative amplitude of the responses of the three effectors elicited by stimulation of the cervical sympathetic nerve at frequencies between 0.2 and 2 Hz. Vasoconstrictor responses were relatively larger than membrane contractions suggesting differences in the mechanisms of neurotransmission at the neuroeffector junctions.     

Development of the projection from the nucleus of the brachium of the inferior colliculus to the superior colliculus in the ferret

Neurons in the deeper layers of the superior colliculus (SC) have spatially tuned receptive fields that are arranged to form a map of auditory space. The spatial tuning of these neurons emerges gradually in an experience-dependent manner after the onset of hearing, but the relative contributions of peripheral and central factors in this process of maturation are unknown. We have studied the postnatal development of the projection to the ferret SC from the nucleus of the brachium of the inferior colliculus (nBIC), its main source of auditory input, to determine whether the emergence of auditory map topography can be attributed to anatomical rewiring of this projection. The pattern of retrograde labeling produced by injections of fluorescent microspheres in the SC on postnatal day (P) 0 and just after the age of hearing onset (P29), showed that the nBIC-SC projection is topographically organized in the rostrocaudal axis, along which sound azimuth is represented, from birth. Injections of biotinylated dextran amine-fluorescein into the nBIC at different ages (P30, 60, and 90) labeled axons with numerous terminals and en passant boutons throughout the deeper layers of the SC. This labeling covered the entire mediolateral extent of the SC, but, in keeping with the pattern of retrograde labeling following microsphere injections in the SC, was more restricted rostrocaudally. No systematic changes were observed with age. The stability of the nBIC-SC projection over this period suggests that developmental changes in auditory spatial tuning involve other processes, rather than a gross refinement of the projection from the nBIC.     

A contribution to the study of the architecture of the autonomic nervous system of the digestive tract of the rat

Summary The distribution of aminergic and non-aminergic nerve fibres to the different constituents of the wall of the digestive tract in various regions is described. Aminergic fibres synapse with all nervous perikarya. Densely interlacing networks of nerve fibres are found in both layers of the tunica muscularis and in the lamina muscularis mucosae. A finely meshed plexus is observed in relation to the wall of the blood vessels in the wall of the gut. There are many fibres connecting the muscular and the vascular plexus. No nerve fibres have been observed in direct relation to the epithelium.The functional implications of these findings are discussed.