三种非典型抗精神病药对儿童青少年精神分裂症患者血脂、肝功能和认知功能的影响

摘要 目的：探讨利培酮、阿立哌唑、奥氮平分别对儿童青少年精神分裂症患者肝功能、血脂和认知功能的影响。方法：选取2015年1月至2019年12月我院收治的84例儿童青少年精神分裂症患者，采用乱数表法随机分为阿立哌唑组（n=28，阿立哌唑治疗）、利培酮组（n=28，利培酮治疗）、奥氮平组（n=28，奥氮平治疗），均治疗8周，对比三组患者症状评分、血脂、肝功能、认知功能以及不良反应。结果：三组治疗8周后阳性与阴性症状量表（PANSS）评分整体比较无差异（P>0.05），三组治疗8周后PANSS评分均较治疗前降低（P<0.05）。奥氮平组、利培酮组治疗8周后三酰甘油(TG)、总胆固醇(TC)、低密度脂蛋白(LDL-C)高于阿立哌唑组，且奥氮平组高于利培酮组（P<0.05）；奥氮平组、利培酮组治疗8周后高密度脂蛋白(HDL-C)低于阿立哌唑组，且奥氮平组低于利培酮组（P<0.05）。三组不良反应发生率整体比较无差异（P>0.05）。阿立哌唑组治疗8周后延迟回忆数、即刻回忆数、回忆总数、再认数评分均高于利培酮组、奥氮平组（P<0.05）。利培酮组治疗8周后ALT、AST、TBIL高于治疗前（P<0.05），利培酮组治疗8周后ALT、AST、TBIL高于阿立哌唑组、奥氮平组（P<0.05）。结论：利培酮、阿立哌唑、奥氮平应用于儿童青少年精神分裂症中，可获得相当的治疗效果，其中利培酮对肝功能影响较大，奥氮平对人体血脂影响较大，阿立哌唑对血脂、肝功能影响轻，改善认知功能效果优于利培酮、奥氮平。

Effects of Three Atypical Antipsychotics on Blood Lipid, Liver Function and Cognitive Function in Children and Adolescents with Schizophrenia

ABSTRACT Objective: To investigate the effects of risperidone, aripiprazole and olanzapine on liver function, blood lipid and cognitive function in children and adolescents with schizophrenia. Methods: 84 cases of children and adolescents with schizophrenia who were admitted to our hospital from January 2015 to December 2019 were selected. They were randomly divided into aripiprazole group (n=28, aripiprazole treatment), risperidone group (n=28, risperidone treatment), olanzapine group (n=28, olanzapine treatment) by randomly number table method. All patients were treated for 8 weeks. Symptom score, blood lipid, liver function, cognitive function and adverse reactions of the three groups were compared. Results: There was no significant difference in positive and negative symptoms scale (PANSS) scores among the three groups at 8 weeks after treatment (P>0.05), 8 weeks after treatment, the scores of PANSS in the three groups were lower than those before treatment (P<0.05), but The levels of triglyceride (TG), total cholesterol (TC), low density lipoprotein (LDL-C) in olanzapine group and risperidone group at 8 weeks after treatment were higher than those in aripiprazole group, and those in olanzapine group were higher than those in risperidone group (P<0.05). The high density lipoprotein (HDL-C) in olanzapine group and risperidone group at 8 weeks after treatment was lower than that in aripiprazole group, and that in olanzapine group was lower than that in risperidone group (P<0.05). There was no significant difference in the incidence rate of adverse reactions among the three groups (P>0.05). 8 weeks after treatment, the scores of delayed recall, immediate recall, total recall and recognition number in aripiprazole group were higher than those in risperidone group and olanzapine group (P<0.05). 8 weeks after treatment, ALT, AST and TBIL in risperidone group were higher than those before treatment (P<0.05), while ALT, AST and TBIL in risperidone group at 8 weeks after treatment were higher than those in aripiprazole group and olanzapine groups(P<0.05). Conclusion: Risperidone, aripiprazole and olanzapine are used in children and adolescents with schizophrenia, they can obtain considerable therapeutic effect. Among them, risperidone has a greater impact on liver function, olanzapine has a greater impact on blood lipid. Aripiprazole has less effect on blood lipid and liver function, and the effect of improving cognitive function is better than risperidone and olanzapine.