目的 选择性评价并探讨近年来精神科临床应用较广的齐拉西酮、利培酮、喹硫平治疗首发和继发性精神分裂症的疗效及安全性。方法 选择中铁二局职业病防治院2005年1月至2011年12月的精神分裂症住院患者210例，分为齐拉西酮组、利培酮组及喹硫平组，每组70例，各组包含首发及复发性患者各35例。其中齐拉西酮组：20～80 mg/d，2次/d；利培酮组：4～7 mg/d，2次/d；喹硫平组：400～1 000 mg/d，2次/d，疗程8周，分别采用PANSS量表评定疗效、TESS量表评定不良反应。结果 首发组各类药物使用疗效比较无显著差异（P＞0.05），且各药物之间的不良反应发生率两两比较无显著差异（P＞0.05）。复发组中，齐拉西酮组疗效与利培酮组和喹硫平组相比均具有显著差异（P＜0.05）。治疗过程中齐拉西酮组不良反应发生率明显高于利培酮、喹硫组（P＜0.05）。结论 齐拉西酮治疗首发精神分裂症的疗效、不良反应与利培酮及喹硫平相似；齐拉西酮治疗复发精神分裂症不良反应与利培酮和喹硫平相当，总体疗效优于利培酮和喹硫平，推荐治疗复发性精神分裂症。

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.