阿立哌唑与利培酮治疗痴呆精神行为症状的疗效及安全性比较

目的观察阿立哌唑和利培酮治疗老年痴呆精神行为症状的疗效及安全性。方法采用随机对照研究，将具有精神行为症状的痴呆患者68例完全随机分为阿立哌唑组及利培酮组，各34例。阿立哌唑组患者服用阿立哌唑，起始剂量2．5mg／d，最大剂量不超过15mg／d；利培酮组患者口服利培酮，起始剂量0．5mg／d，最大剂量不超过3mg／d。疗程均为8周。治疗前和治疗第2、4、8周末采用痴呆病理分析评定量表（BEHAVE—AD）评定疗效，用副反应量表（TESS）评定不良反应，并于入组时和治疗第8周末分别检测2组患者空腹血糖、餐后2h血糖、TC、TG、LDL—C、HDL—C及体重。结果阿立哌唑组和利培酮组患者治疗2、4、8周后BEHAVE—AD评分均明显低于治疗前阿立哌唑组：（14．8±4．2）、（10．2±3．6）、（6．8±2．8）分比（16．4±4．6）分；利培酮组：（15．2±3．9）、（11．8±3．8）、（7．2±3．0）分比（17．2±5．O）分，P〈0．05或P〈0．01]。2组患者间治疗前及治疗后BEHAVE—AD评分比较，差异均无统计学意义（P〉0．05）。2组不良反应发生率均为8．8％（3／34），差异无统计学意义（P〉0．05）。利培酮组治疗8周末体重较治疗前增加明显（71±6）kg比（66±6）kg，P〈0．05]，TG及LDL—C升高分别为（1．62±0．46）mmol／L比（0．96±0．29）mmol／L．（3．82±0．86）mmol／L比（3．08±0．74）mmol／L，而阿立哌唑组则改变不明显（均P〉0．05）。结论阿立哌唑治疗老年痴呆精神行为症状总体疗效、安全性与利培酮相当，但阿立哌唑对患者血糖、血脂及体重影响小于利培酮。

Comparison of efficacy and safety of aripiprazole and risperidone treating behavioral and psychological symptoms of dementia

Objective To assess the effect and safety of aripiprazole and risperidone in the treatment of behavioral and psychological symptoms of dementia （BPSD）. Methods All 68 dementia were randomly divided into aripiprazole group （ n = 34 ） and risperidone group （ n = 34 ） with a course of 8 weeks. Aripiprazole was administered by patients in aripiprazole group with a starting close of 2.5 mg/d and less than the maximum dose 15 mg/d, risperidone was administered by patients in risperidone group with a starting dose of 0.5 mg/d and less than the maximum dose 3 mg/d. Two groups were treated for 8 weeks. BEHAVE-AD and treatment emergent symptom scale （TESS） were used to evaluate the efficacy and adverse effect respectively before and at the ends of 8 weeks treatment. The levels of blood glucose, total cholesterol（TC）, triglyceride（TG）, high density lipoprotein- cholesterol （HDL-C） , low density lipoprotein-cholesterol （LDL-C） and weight were measured at baseline and after 8 weeks. Results After 8 weeks treatment, the scores of BEHAVE-AD in both groups significantly reduced aripiprazole group ： （ 14.8 ± 4.2 ） , （ 10.2± 3.6） , （ 6. g ± 2.6） scores vs （ 16.4 ± 4.6） scores ; risperidone group ： （15.2±3.9）, （11.8±3.8）, （7.2±3.0）scoresvs （17.2±5.0）scores, P〈0.05 orP〈0.01], but there were no significantly differences between the two groups （ P 〉 0.05 ） ; there were few side effects in both groups both 8.8% （3/34） ] , but the weight gaining, TC and LDL-C in risperidone group were higher than those before treatment （71±6）kgvs （66±6）kg, （1. 62 ± 0. 46 ） mmol/L vs （ 0. 96 ± 0. 29 ） mmol/L, （3.82±0.86）mmol/L vs （3.08± 0.74） retooL/L, all P 〈 0.05 ]. Conclusion The results suggest that aripiprazole is as effective and safe as risperidone for the treatment of BPSD, but aripiprazole has less effect on blood glucose, lipids and weight than risperidone.