喹硫平在双相障碍急性期和维持期一年使用剂量的相关因素分析被引量：1

Related factors analysis of quetiapine dosage in acute treatment and 1-year maintenance treatment for bipolar disorder

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摘要目的了解在自然状态下,使用喹硫平治疗双相障碍患者在急性期和维持期1年时的剂量变化情况及影响因素。方法回顾175例住院使用喹硫平系统治疗双相障碍患者的病历资料和临床特征,比较患者在急性期和维持期1年时,喹硫平高剂量组(>300 mg/d)和低剂量组(≤300 mg/d)之间的差异,采用逐步Logistic回归法分析影响因素,受试者工作特征曲线(ROC)和Hosmer-Lemeshow分别评估影响因素的区分度和拟合优度。结果急性期和维持期分别有99.4%和91.4%的患者采用了以心境稳定剂为主的联合治疗方案,急性期喹硫平(n=175)的平均剂量为(395.7±168.2)mg/d,高剂量组的影响因素为:男性(OR=2.712,95%CI:1.372～5.362,P<0.01)、躁狂或混合发作(OR=2.786,95%CI:1.362～5.699,P<0.01)及伴有精神病性症状(OR=2.658,95%CI:1.318～5.361,P<0.01),ROC为0.708,Hosmer-Lemeshow为0.757;维持期喹硫平(n=109)的平均剂量为(267.9±145.9)mg/d,高剂量组的影响因素为:急性期高剂量(OR=1.005,95%CI:1.003～1.008,P<0.01),ROC为0.736,Hosmer-Lemeshow为0.616。结论临床医生在治疗男性、躁狂或混合发作、伴精神病性症状的双相障碍急性期患者时应考虑使用较高剂量喹硫平;双相障碍维持期1年时喹硫平剂量可参考急性期用量进行调整。 Objective To explore the factors associated with quetiapine dosage in acute treatment and 1-year maintenance treatment for bipolar disorder in natural clinical status. Methods Documents and clinical features of 175 patients with bipolar disorders treated with quetiapine were reviewed to compare the differences between high-dose group （〉 300 mg/d） and low-dose group （ ≤300 mg/d） in acute treatment and 1 -year maintenance treatment respectively. Stepwise logistic regression model was used to identify the influencing factors. The area under ROC curve and Hosmer - Lemeshow goodness-of-fit statistic were used to evaluate the discrimination and goodness of fittest of influencing factors Results The rate of combination treatment with mood stabilizers was 99.4% in acute treatment and 91.4% in 1-year maintenance treatment. The average daily dose of quetiapine in acute treatment （175 cases） was （395.7 ± 168.2） mg/ d. Influencing factors associated with high-dose quetiapine included male gender （ OR = 2. 712, 95% CI： 1. 372 5. 362,P 〈 0.01 ） , manic or mixed episode （ OR = 2. 786, 95 % CI： 1. 362 - 5. 699, P 〈 0.01 ） and concomitant with psychotic symptoms （OR =2. 658, 95% CI： 1. 318 ±5. 361, P 〈0.01 ）. The overall model demonstrated goodness-of- fit （ Hosmer-Lemeshow was 0. 757） with an area under ROC curve of 0. 708. The average daily dose of quetiapine in 1- year maintenance treatment （ 109 cases） was （267.9 ＋ 145.9） mg/d. High-dose quetiapine in acute treatment （ OR = 1. 005, 95% CI： 1. 003 ± 1. 008,P 〈 0.01 ） was individually associated with high-dose quetiapine in maintenance treatment. The overall model demonstrated goodness-of-fit （ Hosmer-Lemeshow was 0. 616 ） with an area under ROC curve of 0. 736. Conclusion Higher dose of quetiapine should be prescribed for patients with features such as male gender, manic or mixed episode, concomitant with psychotic symptoms in acute treatment for bipolar disorder. The dose of quetiapine in acute treatment may be regarded a referent to determine the dosage of quetiapine in 1-year maintenance treatment.

作者张玲马辛王刚罗炯张庆娥赵茜邓齐英

机构地区首都医科大学附属北京安定医院

出处《精神医学杂志》 2012年第4期257-260,共4页 Journal of Psychiatry

关键词喹硫平双相障碍急性期维持期剂量 Quetiapine Bipolar disorder Acute treatment Maintenance treatment Dosage

分类号 R749.4 [医药卫生—神经病学与精神病学]

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