第二代抗精神病药治疗精神分裂症患者血药浓度与临床疗效的研究进展

精神分裂症是一组病因复杂、往往累及终生的常见精神病性障碍,需要长期抗精神病药物治疗,第二代抗精神病药对阳性症状、阴性症状和认知障碍均有一定疗效,目前已作为一线用药,但不同患者对药物的有效治疗剂量及耐受性的差异仍较大。本文通过归纳总结第二代抗精神病药总的血药浓度或活性代谢产物血浆水平与疗效的关系,试图找到疗效最好且副作用最少的最佳血药浓度及药物剂量,实现个体化合理用药。结果表明各阳性结果之间有效血药浓度不一,尚无令人满意的结果。但是,当剂量固定之后结果较稳定。目前仍更需大量设计严谨、大样本的研究来明确抗精神病药血药浓度的最佳水平来指导临床工作。

Relationship between clinical efficacy and blood concentrationof second-generation antipsychotics in patients with schizophrenia

Schizophrenia is a life-long illness requiring indefinite maintenance and antipsychotic treatment.Second-generation antipsychotics are believed to have a superior effect on the positive,negative and cognitive symptoms of schizophrenia.However,some drugs may show high interindividual variability in blood levels.This review summarizes the relationship between the total blood concentration or active metabolite plasma level of second-generation antipsychotics and their efficacy,in order to find the optimal blood concentration.The results vary largely among the positive results,and limited evidence from fixed-dose studies is encouraging.More well-designed trials with large samples are needed to clarify the optimal blood concentration of antipsychotics.