目的 選擇性評價并探討近年來精神科臨床應用較廣的齊拉西酮、利培酮、喹硫平治療首發(fā)和繼發(fā)性精神分裂癥的療效及安全性。方法 選擇中鐵二局職業(yè)病防治院2005年1月至2011年12月的精神分裂癥住院患者210例，分為齊拉西酮組、利培酮組及喹硫平組，每組70例，各組包含首發(fā)及復發(fā)性患者各35例。其中齊拉西酮組：20～80 mg/d，2次/d；利培酮組：4～7 mg/d，2次/d；喹硫平組：400～1 000 mg/d，2次/d，療程8周，分別采用PANSS量表評定療效、TESS量表評定不良反應。結(jié)果 首發(fā)組各類藥物使用療效比較無顯著差異（P＞0.05），且各藥物之間的不良反應發(fā)生率兩兩比較無顯著差異（P＞0.05）。復發(fā)組中，齊拉西酮組療效與利培酮組和喹硫平組相比均具有顯著差異（P＜0.05）。治療過程中齊拉西酮組不良反應發(fā)生率明顯高于利培酮、喹硫組（P＜0.05）。結(jié)論 齊拉西酮治療首發(fā)精神分裂癥的療效、不良反應與利培酮及喹硫平相似；齊拉西酮治療復發(fā)精神分裂癥不良反應與利培酮和喹硫平相當，總體療效優(yōu)于利培酮和喹硫平，推薦治療復發(fā)性精神分裂癥。

Objective To evaluate and investigate the efficacy and adverse effect profiles of three widely used atypical antipsychotics such as ziprasidone, risperidone, and quetiapine on the patients with first-episode and recurrent schizophrenia. Methods A total of 210 patients with schizophrenia in Hospital of China Railway Erju Co., Ltd. during Jan 2005 to Dec 2011 were randomly divided into ziprasidone (20―80 mg/d), quetiapine (4―7 mg/d), and risperidone (400―1 000 mg/d) groups with 70 cases (35 first-episode cases and 35 recurrent cases) in each group, and administrated twice daily, in a single-blind 8-week controlled trial. PANSS and TESS rating scales were used to evaluate the efficacy and adverse effect, respectively. Results There was no statistically significant difference among the three compounds in adverse effects and relative efficacies in patients with first-episode schizophrenia (P > 0.05). The effect of ziprasidone was significantly different from that of other two compounds in patients with recurrent schizophrenia (P < 0.05), but there was no significant difference in adverse effect between patients with recurrent schizophrenia for each two of the three compounds (P > 0.05). Conclusion The efficacy and adverse effect of ziprasidone are similar to those of quetiapine and risperidone in the treatment of first-episode schizophrenia; In the treatment of recurrent schizophrenia, the adverse effect of ziprasidone is similar to that of quetiapine and risperidone, but the therapeutic effect is better than that of quetiapine and risperidone.