论文部分内容阅读
目的:探讨富马酸喹硫平联合碳酸锂治疗双相情感障碍的临床效果及对患者认知功能的影响。方法:选取诸暨市第五人民医院2017年1月至2019年12月收治的双相情感障碍患者60例为研究对象，按照随机数字表法分为对照组和联合组，每组30例。对照组患者采用碳酸锂治疗，联合组患者在对照组给药的基础上加用富马酸喹硫平治疗，均治疗4周。比较两组患者治疗前及治疗4周后的躁狂及抑郁症状改善情况，临床治疗效果，认知功能及不良反应；同时在治疗前及治疗4周后抽取空腹静脉血，测定两组患者血清超氧化物歧化酶（SOD）、丙二醛（MDA）、过氧化氢酶（CAT）及谷胱甘肽过氧化物酶（GSH-Px）的含量。结果:与治疗前比较，两组患者的贝壳-拉范森躁狂量表（BRMS）和汉密尔顿抑郁自评量表（HAMD）评分均显著降低（n t=10.39、12.47，均n P < 0.001），简易精神状态检查量表（MMSE）评分均显著提高（ n t=8.36、14.52，均n P < 0.001），且与对照组比较，联合组治疗后BRMS、HAMD评分均显著降低（ n t=5.86、5.54，均n P < 0.001），MMSE评分显著提高（ n t=2.40，n P=0.020）。联合组临床治疗有效率显著高于对照组（n Z=2.16，n P=0.030）。治疗后，两组患者血清MDA含量均显著降低（n t=8.72、15.47，均n P < 0.001），SOD、CAT及GSH-Px含量均显著增加（SOD： n t对照组=2.84，n P=0.006，n t联合组=4.05，n P < 0.001；CAT： n t对照组=5.20，n P < 0.001， n t联合组=9.86，n P < 0.001；GSH-Px： n t对照组=2.67，n P=0.010，n t联合组=3.71，n P=0.001），与对照组比较，联合组治疗后血清MDA含量显著降低（n t=12.38，n P < 0.001），SOD及CAT的含量均显著增加（ n tSOD=2.24，n P=0.029；n tCAT=2.72，n P=0.009）。联合组与对照组不良反应发生率［20.00%（6/30）比16.67%（5/30）］差异无统计学意义（χn 2=1.02，n P=0.907）。n 结论:碳酸锂联合富马酸喹硫平能显著改善双相情感障碍患者的临床症状，提高认知能力，并减少氧化应激的过度激活，具有一定的临床应用价值。“,”Objective:To investigate the efficacy of quetiapine fumarate combined with lithium carbonate in the treatment of bipolar disorder and its effect on cognitive function.Methods:Sixty patients with bipolar disorder, who received treatment in Zhuji Fifth People\'s Hospital from January 2017 to December 2019, were included in this study. They were randomly assigned to receive either lithium carbonate (control group, n n = 30) or quetiapine fumarate combined with lithium carbonate treatment (combined treatment group, n n = 30). All patients received 4 weeks of treatment. Manic and depressive symptoms pre- and post-treatment, clinical efficacy, cognitive function, and adverse reactions were compared between the two groups. Fasting venous blood was taken before and 4 weeks after treatment to measure superoxide dismutase (SOD), malondialdehyde (MDA), catalase (CAT), and glutathione peroxidase (GSH-Px) levels.n Results:The scores of the Bech-Rafaelsdn Mania Rating Scale (BRMS) and the Hamilton Rating Scale for Depression (HAMD) in each group were significantly decreased after treatment compared with before treatment (n t = 10.39, 12.47, both n P < 0.001). The score of the Mini-Mental State Examination in each group significantly increased after treatment compared with before treatment ( n t = 8.36, 14.52, both n P < 0.001). The scores of BRMS and HAMD post-treatment were significantly lower in the combined treatment group than in the control group ( n t = 5.86, 5.54, both n P < 0.001). The score of MMSE post-treatment was significantly higher in the combined treatment group than in the control group ( n t = 2.40, n P = 0.020). The response rate was significantly higher in the combined treatment group than in the control group (n Z = 2.16, n P = 0.030). After treatment, serum MDA level significantly decreased in each group compared with before treatment (n t = 8.72, 15.47, both n P < 0.001). After treatment, SOD, CAT and GSH-Px levels were significantly increased in each group compared with before treatment (SOD: n tcontrol group = 2.84, n P = 0.006, n tcombined treatment group = 4.05, n P < 0.001; CAT: n tcontrol group = 5.20, n P < 0.001, n tcombined treatment group = 9.86, n P < 0.001; GSH-Px: n tcontrol group = 2.67, n P = 0.010, n tcombined treatment group = 3.71, n P = 0.001). Serum MDA level post-treatment was significantly lower in the combined treatment group than in the control group (n t = 12.38, n P < 0.001). Serum SOD and CAT levels post-treatment were significantly higher in the combined treatment group than in the control group ( n tSOD = 2.24, n P = 0.029; n tCAT = 2.72,n P = 0.009). There was no significant difference in the incidence of adverse reactions between the combined treatment and control groups [20.00% (6/30) n vs. 16.67% (5/30), n χ2 = 1.02, n P = 0.907).n Conclusion:Quetiapine fumarate combined with lithium carbonate can greatly improve clinical symptoms and cognitive function and reduce the over-activation of oxidative stress in patients with bipolar disorder. The combined therapy is of certain clinical application value.