CAJ | 학술논문

目的：了解加味生铁落饮治疗痰火上扰证狂病伴危险行为患者的效果。方法选取符合狂病伴危险行为患者100例，将诊断为痰火上扰证且符合精神分裂症伴发危险行为的56例患者随机分为加味生铁落饮联用利培酮组(治疗组)与单用利培酮组(单用组)。疗程4周，随访12个月。于治疗前及治疗1、2、3、4周分别采用危险行为分级量表评定危险行为；治疗前后采用阳性和阴性症状量表(PANSS)、不良反应量表(TESS)、健康状况问卷(SF-36)、大体评定量表(GAS)评定疗效、不良反应、生存质量，统计复发、再住院情况、危险行为改善情况。结果治疗组总有效率为82.1%，单用组为75.0%，两组比较差异无统计学意义(P>0.05)；治疗组控制危险行为平均起效时间为(16.01±2.38)d，单用组为(20.93±2.25)d，两组比较差异有高度统计学意义(P<0.01)。治疗组第1周危险行为降到3级以下达57%，单用组达46%；治疗组第4周危险行为降到3级以下达100%，单用组达89%，两组比较差异均有高度统计学意义(均P<0.01)。两组治疗后阳性症状分、阴性症状评分、一般精神病理评评分、总分均显著下降(均P<0.01)；两组间比较差异无统计学意义(P>0.05)。两组不良反应发生率比较差异有高度统计学意义(P<0.01)。治疗组的复发率、再住院率、社会功能缺陷率要显著低于单用组(P<0.01)。治疗组SF-36多个因子分及总分明显高于单用组(P<0.05或P<0.01)。结论加味生铁落饮联用治疗痰火上扰证狂病且符合精神分裂症危险行为患者的疗效等同于单用利培酮组，危险行为改善明显且起效时间短，不良反应发生率低，复发率、再住院率、社会功能缺陷率低，可以有效改善生存质量，是一种对痰火上扰证狂病且符合精神分裂症危险行为患者的较好疗法，宜扩大样本、延长随访时间深入研究。
목적：료해가미생철락음치료담화상우증광병반위험행위환자적효과。방법선취부합광병반위험행위환자100례，장진단위담화상우증차부합정신분렬증반발위험행위적56례환자수궤분위가미생철락음련용리배동조(치료조)여단용리배동조(단용조)。료정4주，수방12개월。우치료전급치료1、2、3、4주분별채용위험행위분급량표평정위험행위；치료전후채용양성화음성증상량표(PANSS)、불량반응량표(TESS)、건강상황문권(SF-36)、대체평정량표(GAS)평정료효、불량반응、생존질량，통계복발、재주원정황、위험행위개선정황。결과치료조총유효솔위82.1%，단용조위75.0%，량조비교차이무통계학의의(P>0.05)；치료조공제위험행위평균기효시간위(16.01±2.38)d，단용조위(20.93±2.25)d，량조비교차이유고도통계학의의(P<0.01)。치료조제1주위험행위강도3급이하체57%，단용조체46%；치료조제4주위험행위강도3급이하체100%，단용조체89%，량조비교차이균유고도통계학의의(균P<0.01)。량조치료후양성증상분、음성증상평분、일반정신병리평평분、총분균현저하강(균P<0.01)；량조간비교차이무통계학의의(P>0.05)。량조불량반응발생솔비교차이유고도통계학의의(P<0.01)。치료조적복발솔、재주원솔、사회공능결함솔요현저저우단용조(P<0.01)。치료조SF-36다개인자분급총분명현고우단용조(P<0.05혹P<0.01)。결론가미생철락음련용치료담화상우증광병차부합정신분렬증위험행위환자적료효등동우단용리배동조，위험행위개선명현차기효시간단，불량반응발생솔저，복발솔、재주원솔、사회공능결함솔저，가이유효개선생존질량，시일충대담화상우증광병차부합정신분렬증위험행위환자적교호요법，의확대양본、연장수방시간심입연구。
Objective To explore the effect of Modified Sheng Tie Lao Decoction in the treatment of patients with up-ward flaming of phlegm-fire of manic psychosis together with dangerous behavior. Methods One hundred patients with manic psychosis together with dangerous behavior were chosen, and 56 cases of patients diagnosed as upward flaming of phlegm-fire and meeting schizophrenia combined with dangerous behavior were randomly divided into Modified Sheng Tie Lao Decoction combined with Resperidone group (treatment group) and Resperidone alone group (single group). The course was 4 weeks, followed-up for 12 mouths. The dangerous behavior was assessed by dangerous behav-ior rating scale before treatment and after treatment for 1, 2, 3, 4 weeks. The effect, adverse reactions and quality of life were assessed by positive and negative syndrome scale (PANSS), treatment emergent symptom scale (TESS), the medical outcomes study 36-item short-form health survey (SF-36), global assessment scale (GAS). The recurrence, re-hospitalization, improvement of dangerous behavior were recorded . Results The total effective rate of treatment group was 82.1%, which of the single group was 75.0%, there was no statistically significant difference between the two groups (P>0.05);the average onset time of con-trolling risk behavior in the treatment group was (16.01±2.38) days, which of single group was (20.93±2.25) days, there was a statistically significant difference between the two groups (P < 0.01). The rate of dangerous behavior de-creasing to three levels below in the first week in treatment group reached to 57%, which of the single group reached to 46%; the rate of dangerous behavior decreasing to three levels below in the fourth week in treatment group reached to 100%, which of the single group reached to 89%, there were statistically significant differences between the two groups (all P < 0.01). The scores of positive symptoms, negative symptoms, general psychopathology and total scores after treatment were all reduced obviously, there were statistically significant differences (all P< 0.01), while there were no statistically significant differences between the two groups (P> 0.05). The incidence of adverse reactions between the two groups had a statistically significant difference (P<0.01). The recurrence rate, rehospitalization rate, social disabil-ity rate of treatment group were all significantly lower than those of single group (P< 0.01). Several factor scores and total scores of treatment group were all significantly higher than those of single group (P<0.05 or P<0.01). Conclu-sion Combined treatment of Modified Sheng Tie Lao Decoction in patients with upward flaming of phlegm-fire of manic psychosis and meeting schizophrenia combined with dangerous behavior has the almost same effect with Resperidone alone group, dangerous behaviors are improved obviously and onset time is more shorter, the incidence of adverse reac-tions is low, the recurrence rate, rehospitalization rate, social disability rate are all low, can significantly improve the quality of life, which is a good therapy for patients with upward flaming of phlegm-fire of manic psychosis and meeting schizophrenia combined with dangerous behavior. It is necessary to expand the sample and the time of follow-up for further study.