帕利哌酮联合奥氮平对 BPD 躁狂发作的 疗效及对患者肠道菌群的影响

Efficacy of Paliperidone in Combination with Olanzapine in Manic Episodes of BPD and Its Effect on the Intestinal Flora of Patients

摘要:

〔摘 要〕 目的：探讨帕利哌酮联合奥氮平对双相情感障碍（BPD）躁狂发作的疗效及对患者肠道菌群的影响。 方法：选择 2020 年 4 月至 2022 年 12 月南阳市第四人民医院收治的 86 例 BPD 躁狂发作患者，随机分为两组，各 43 例，对照组 患者予以奥氮平治疗，观察组患者予以帕利哌酮联合奥氮平治疗，于治疗前后比较两组患者的倍克–拉范森躁狂量表（BRMS） 评分、阳性和阴性精神症状评定量表（PANSS）评分，血清脑源性神经营养因子（BDNF）、胶质细胞源性神经营养因子（GDNF） 水平以及肠道菌群分布情况。 结果：治疗后，两组患者 BRMS 评分、PANSS 评分均较治疗前显著下降，且观察组患者均 显著低于对照组，差异均具有统计学意义（P ＜ 0.05）；两组患者治疗前后的血清 BDNF 水平比较，差异均无统计学意义 （P ＞ 0.05）；治疗后，两组患者的 GDNF 水平均较治疗前升高，并且观察组患者高于对照组，差异均具有统计学意义 （P ＜ 0.05）；观察组患者治疗后肠道双歧杆菌数量较治疗前明显增加，差异具有统计学意义（P ＜ 0.05）；其他菌群分布 情况的组内、组间比较，差异均无统计学意义（P ＞ 0.05）；两组患者治疗期间的不良反应发生率比较，差异无统计学意义 （P ＞ 0.05）。 结论：帕利哌酮联合奥氮平治疗 BPD 躁狂发作具有更好的疗效，两药联合能更有效地提高患者血清 GDNF 水平， 增加患者肠道菌群中双歧杆菌的数量，安全性高。

Abstract:

〔Abstract〕 Objective To investigate the efficacy of paliperidone combined with olanzapine on bipolar disorder (BPD) manic episodes and the effect on the intestinal flora of patients. Methods 86 patients with BPD manic episodes admitted to Nanyang Fourth People's Hospital from April 2020 to December 2022 were randomly divided into two groups of 43 patients in each group, the control group was treated with olanzapine and the observation group was treated with paliperidone combined with olanzapine. The Baker-Raphanson Mania Scale (BRMS) score, positive and negative psychiatric symptom scale (PANSS) score, the level of serum brain-derived neurotrophic factor (BDNF) and glial cell-derived neurotrophic factor (GDNF) and the distribution of intestinal flora in the two groups were compared before and after treatment. Results After treatment, the scores of BRMS score and PANSS in the two groups were significantly decreased compared with before treatment, and the scores of the observation group were significantly lower than those in the control group, the differences were statistically significant (P < 0.05). There was no significant difference in BDNF between the two groups before and after treatment (P > 0.05). After treatment, the levels of GDNF in the two groups were higher than those before treatment, and the level of the observation group was higher than that in the control group, the differences were statistically significant (P < 0.05). The number of intestinal bifidobacterium in the observation group after treatment was significantly increased compared with that before treatment, the difference was statistically significant (P < 0.05). There was no significant difference in the distribution of other bacteria groups within or between groups (P > 0.05). There was no significant difference in the incidence of adverse reactions between the two groups (P > 0.05). Conclusion Paliperidone combined with olanzapine has better efficacy in the treatment of manic episodes in BPD, and the combination of the two drugs can more effectively increase the level of serum GDNF and the number of bifidobacteria in the intestinal flora of patients with high safety.