长期服用利培酮或传统抗精神病药对精神分裂症QTc间期的作用

目的探究精神分裂症患者长期服用利培酮或传统抗精神病药对其QTc间期的影响。方法102例精神分裂症患者,根据治疗方法不同分为利培酮组和传统组,每组51例。利培酮组患者服用利培酮进行治疗,传统组患者服用传统抗精神病药进行治疗。对比两组患者的临床指标[总病程、治疗时间、QTc间期、心率、天门冬氨酸氨基转移酶(AST)、低密度脂蛋白胆固醇(LDL-C)、空腹血糖(FPG)、血钙(Ca)、乳酸脱氢酶(LDH)、肌酸激酶(CK)、总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)]。结果利培酮组患者的治疗时间(28.61±6.58)个月、QTc间期(397.25±15.54)ms均短于传统组的(55.96±7.18)个月、(425.62±19.52)ms,差异具有统计学意义(P<0.05);利培酮组患者的空腹血糖(5.38±1.23)mmol/L低于传统组的(5.78±0.10)mmol/L、血钙(2.42±0.13)mmol/L高于传统组的(2.35±0.16)mmol/L,差异具有统计学意义(P<0.05)。两组患者的总病程、心率、天门冬氨酸氨基转移酶、乳酸脱氢酶、肌酸激酶、总胆固醇、甘油三酯、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇水平比较差异均无统计学意义(P>0.05)。结论精神分裂症患者长期服用利培酮治疗效果优于传统抗精神病药,利培酮对QTc间期的影响较小。     

代谢综合征及其组分与QTc间期延长的相关性

目的 了解城市社区老年人群代谢综合征(MS)及其组分与校正的QT间期(QTc间期)延长的相关性。方法 采用典型抽样流行病学调查方法对2011年9-11月1 046例宁夏回族自治区5城市社区老年人群进行问卷调查、体格检查，其中1 028例完成生化指标、心电图检查等，既往存在冠心病、心律失常等心血管疾病者233例，最终纳入795例。以2004年中华医学会糖尿病学分会提出的MS诊断标准及QTc间期延长(QTc>440 ms)为依据分为MS组、非MS组和正常组。分析MS及其不同组分，以及吸烟、饮酒与QTc间期延长的相关性。结果 MS组患者QTc间期明显长于非MS组，血压升高组、血糖升高组，以及吸烟组、饮酒组患者QTc间期明显长于正常组，差异均有统计学意义(P<0.05);超重/肥胖组、血脂异常组患者QTc间期长于正常组，但差异无统计学意义(P>0.05)。QTc间期延长与MS、空腹血糖、收缩压均呈正相关(P<0.05);空腹血糖升高、收缩压升高是QTc间期延长的危险因素(P<0.05)。结论 MS与QTc间期延长显著相关，空腹血糖、血压升高可能是QTc延长的危险因...     

舍曲林联合抗精神病药物治疗精神分裂症后抑郁患者的效果研究

目的探讨舍曲林联合抗精神病药物治疗精神分裂症后抑郁患者的效果。方法100例精神分裂症后抑郁患者,随机分为抗精神病药物单一治疗组和抗精神病药物+舍曲林组,每组50例。抗精神病药物单一治疗组采取抗精神病药物治疗,抗精神病药物+舍曲林组在实施抗精神病药物治疗的基础上给予舍曲林治疗。比较两组的治疗效果;治疗前后汉密尔顿抑郁量表(HAMD)评分、阳性和阴性症状量表评分;阳性和阴性症状量表评分降低50%的时间、HAMD评分降低50%时间;不良反应发生情况。结果抗精神病药物+舍曲林组治疗总有效率100.00%高于抗精神病药物单一治疗组的86.00%,差异具有统计学意义(P<0.05)。治疗后,抗精神病药物+舍曲林组HAMD评分(6.56±1.21)分、阳性和阴性症状量表评分(45.19±2.51)分均低于抗精神病药物单一治疗组的(10.56±1.89)、(65.45±4.77)分,差异有统计学意义(P<0.05)。抗精神病药物+舍曲林组阳性和阴性症状量表评分降低50%的时间、HAMD评分降低50%时间分别为(7.12±1.21)、(9.26±1.26)d,短于抗精神病药物单一治疗组的(9.78±1.71)、(12.78±1.70)d,差异具有统计学意义(t=8.979、11.763,P<0.05)。两组不良发应发生率均为4.00%,差异无统计学意义(χ^2=0,P>0.05)。结论抗精神病药联合舍曲林治疗精神分裂症后抑郁患者的效果确切,可加速患者的抑郁心理和精神分裂症状改善,且未增加副作用。     

关节镜监视下有限切开复位、锁定钢板内固定治疗胫骨平台骨折

目的研究系统性红斑狼疮(systemic lupus erythematosus,SLE)患者QT间期离散度(QT-interval dispersion,QTd)的变化与心脏损害及病程、疾病活动、抗心磷脂抗体等临床资料的相关性。方法选取173例SLE患者和70例性别、年龄匹配的健康对照者,回顾性地分析SLE患者的临床资料,测量每份心电图12导联的QT间期计算QTd。结果 (1)SLE患者QTd较健康对照者明显延长(P<0.01),其中有明显心脏损害SLE患者QTd较无明显心脏损害SLE患者和健康对照者明显延长(P<0.01;P<0.01),无明显心脏损害SLE患者QTd较健康对照者明显延长(P<0.01);(2)SLE患者晚期组QTd较早期组和初发组明显延长(P<0.01;P<0.01);(3)SLE重度活动组QTd较轻度活动组和稳定组明显延长(P<0.05;P<0.05);(4)SLE抗心磷脂抗体阳性组QTd较抗心磷脂抗体阴性组明显延长(P<0.05);(5)SLE患者QTd与病程、疾病活动指数(SLEDAI)、抗dsDNA抗体、收缩压、舒张压呈正相关(分别:r=0.176,P<0.05;r=0.178,P<0.05;r=0.172,P<0.05;r=0.393,P<0.01;r=0.355,P<0.01)。结论 SLE患者QTd明显延长并与多种心脏损害的危险因素相关。QTd可能是SLE患者心脏损害的一个有用的评价指标。     

黄芪注射液辅助治疗对慢性精神分裂症患者生物学的影响及疗效观察

目的:观察黄芪注射液辅助治疗对慢性精神分裂症患者生物学的影响及临床疗效。方法:将100例慢性精神分裂症患者随机分为2组,其中观察组50例,在常规服用抗精神病药物治疗的基础上加用黄芪注射液静脉滴注,每天40mL,每个疗程7天,共4个疗程;对照组50例,仅常规服用抗精神病药物,不配合中药治疗,疗程同观察组。2组均辅用苯二氮类药,但不能辅用其它催眠类药物。结果:治疗后2组在心电图中QTc间期变化、血糖变化、疗效、PANSS总分及分量表分、副反应方面均存在显著性差异(P<0.05或P<0.01)。结论:黄芪注射液辅助治疗慢性精神分裂症可提高疗效、降低副反应。     

个体化护理干预对住院精神分裂症患者便秘的影响研究

目的探讨个体化护理干预对住院精神分裂症患者便秘的影响。方法将住院精神分裂症患者100例按随机数字表法分为研究组和对照组,每组50例。2组均接受抗精神病药物系统治疗和精神科常规护理,研究组在此基础上给予个体化护理干预12周,干预前,后用护士用住院患者观察量表(NOSIE)进行评定,同时进行干预前后2组患者便秘改善情况调查。结果 100例患者中发生便秘42例(42%)。抗精神病药物之间比较,服用氯氮平和利培酮的患者与服用其他抗精神病药患者便秘发生率差异有统计学意义(P<0.05)。不同因素对精神分裂症患者便秘的影响比较,合并用安坦患者,不同年龄、管理方式、住院次数之间,差异有统计学意义(P<0.05)。个体化护理干预后,干预组NOSIE总积极因素分、总消极因素分及各因子分与对照组比较差异有统计学意义(P<0.05);与干预前比较,各因子分差异有统计学意义(P<0.05)。2组患者干预前、后便秘情况比较,干预效果从4周后开始显现,差异有统计学意义(P<0.05)。结论个体化护理干预有助于改善住院精神分裂症患者便秘,提高患者生活质量,促进疾病康复。     

精神病患者QTc间期异常与精神病药物治疗的关系

精神病患者心血管病死率高 ,精神病患者应用抗精神病药物治疗后可发生不能解释的猝死 ,可能是药物诱发的心律失常所致 ,因为许多抗精神病药物的心脏电生理作用与奎尼丁相似。据报道 ,抗精神病药物过量可导致多形性室速 ,即尖端扭转型室性心动过速。QTc延长是心脏病患者猝死的预测因素 ,药物诱发的 QTc间期延长程度是心律失常危险的重要标志。本文旨在确定精神病患者 QTc延长发生率 ,评价 QTc延长与抗精神病药物、用药剂量或其他危险因素的相关性。495例精神病患者及 1 0 1例健康对照者行心电图检查 ,应用逻辑回归方法对比两者 QTc,QT离…     

索他洛尔改变慢性心房纤颤患者QT离散度的观察

目的观察索他洛尔对慢性心房纤颤患者心电图QT离散度的影响,评价其临床意义。方法比较治疗组52例慢性房颤患者服药前与服药14d后的心电图QT间期、心率校正QT间期(QTc)、QT离散度(QTd)以及心率校正QT离散度(QTcd)的改变,并与健康对照组52例对比。结果治疗组服药14d后,QT、QTc均较治疗前延长(P<0.05),但QTd和QTcd较服药前缩短(P<0.01)。治疗组和健康对照组服药前后对比,前者QT、QTc、QTd、QTcd均显著延长(P<0.05)。结论索他洛尔使慢性心房纤颤患者QT间期和QTc延长,而使QTd、QTcd适度缩短,这与其抗心律失常的电生理特性有关。     

静脉注射伊布利特对中国健康受试者及房颤与房扑患者心电图QTc间期的影响

目的 静脉注射伊布利特(抗心律失常药物)对健康人及房颤与房扑患者用药后心电图QTc间期变化的比较研究.方法 40例健康男性随机分为6组(每组分别为4,10,6,6,6,8人),分别静脉注射伊布利特5,10,20μg·kg-1及单次给药0.5,0.75,1.0mg.房颤、房扑患者各100例应用伊布利特(1 mg iv;体质量小于60 kg者,按0.01 mg·kg-1)转复心律治疗,必要时重复给药1次.结果 健康受试者药后QTc间期明显延长,峰值出现于给药完成后.5,10,20μg·kg-1组R QTc均值最大值分别为(469±7),(592±35)及(678±14)ms;0.5,0.75,1.0 mg组的最大值分别为(605±39),(616±8)及(683±9)ms.100例房颤、房扑患者的药后QTc间期延长,峰值出现于静脉注射结束即刻;1次给药者QTc峰值为(476±9)ms;2次给药者QTc峰值为(510±8)ms,于4 h恢复基线水平.相同给药方式,健康受试者较患者的QTc间期延长更为显著(P<0.05).有43%接受2次给药的患者,QTc可延长至500～600 ms;9%可延长至600 ms以上.发生1例尖端扭转型室性心动过速(1%)、2例室性心动过速(2%).结论 静脉注射伊布利特后,中国健康受试者和房颤、房扑患者QTc间期均明显延长,最大可达600 ms以上;但健康人QTc延长较房颤、房扑患者更显著.要严密监测QTc间期至少应到药后4 h.     

左氧氟沙星对2型糖尿病合并感染患者的QTc间期影响*

目的:探讨左氧氟沙星治疗2型糖尿病合并感染时,对患者QTc(QT校正间期)的影响;并探求引起QTc变化的危险因素。方法:收集2015-2018年我院住院的2型糖尿病且有细菌性感染迹象给予左氧氟沙星治疗的患者一般资料、糖化血红蛋白、血糖、血脂、12导联心电图。共入选2型糖尿病合并细菌性感染病例182例,予治疗前及治疗7日后测定静息态心电图,计算QTc间期。结果与结论:在238例患者中,用药前有56例存在QTc间期延长,占比23.53%,在治疗后有94例存在QTc间期延长,占比39.49%,治疗后QTc间期延长发生率高于治疗前,两者存在统计学差异。治疗前平均QTc为0.41 s,治疗后平均QTc为0.43 s,整体延长4.87%,两者存在统计学差异。通过Logistic回归分析表明QTc间期延长与性别、年龄、是否合并糖尿病周围神经病变、糖化血红蛋白水平以及糖尿病病程相关,为糖尿病患者使用左氧氟沙星发生心律失常的危险因素。     

QTc interval prolongation and antipsychotic drug treatments: focus on sertindole

Since the 1960s, physicians have been aware of electrocardiographic (ECG) abnormalities and cases of sudden death associated with the use of antipsychotic drugs in patients with schizophrenia. Explanations for such deaths have traditionally focused on drug-induced prolongation of the QT interval leading to the development of life-threatening ventricular arrhythmias such as torsade de pointes (TdP). It is now apparent that most conventional and atypical antipsychotics can cause dose-related prolongation of the corrected QT interval (QTc), although there are important differences in the potency of individual agents. This review discusses potential mechanisms underlying QTc prolongation and arrhythmogenesis and examines the evidence for a relationship between antipsychotic drugs and prolongation of the QTc interval. New electrophysiological and epidemiological data are presented which suggest there may not be a clear-cut cause-effect relationship between QTc prolongation and the development of ventricular tachyarrhythmias for all atypical antipsychotics. For at least one of these agents (sertindole), counterbalancing mechanisms may act to reduce the risk of proarrhythmic activity arising as a result of QTc prolongation.     

Sex difference in QTc prolongation in chronic institutionalized patients with schizophrenia on long-term treatment with typical and atypical antipsychotics

Objective

The rate-corrected electrocardiographic QT (QTc) interval may significantly increase in patients with schizophrenia taking antipsychotics. The objective of this naturalistic study was to assess the prevalence of prolonged QTc interval in a large population of inpatients with chronic schizophrenia and to explore QTc relationship with demographic variables and prescribed treatments.

Materials and methods

Electrocardiograms were obtained from age- and sex-matched 456 controls and 1,006 inpatients with schizophrenia (male/female?=?689/317) taking antipsychotics. QTc prolongation was defined as a mean value of two standard deviations above the controls. The adjusted relative risk was calculated using logistic regression analysis.

Results

QTc prolongation was present in 45 (4.5%) of 1,006 patients overall. Fewer men (3.2%, 22 of 689) than women (7.3%, 23 of 317) displayed QTc prolongation (p?<?0.004). Moreover, QTc intervals were shorter in male (391?±?31?ms) than female subjects (400?±?37?ms) (p?<?0.001). Clozapine was found to produce a longer QTc intervals compared to risperidone and typical antipsychotics. Furthermore, multiple regression analysis showed that significant predictors for QTc prolongation were comorbid cardiovascular disease, antipsychotic types, sex, and age (all p?<?0.01).

Conclusion

Our present findings suggest that there are sex differences in the prevalence of QTc prolongation and QTc lengthening in schizophrenia. Antipsychotic types are risk factors for QTc prolongation, and risks are substantially higher for clozapine.     

Comparison of the metabolic effects observed in patients treated with ziprasidone versus olanzapine

This study aimed to examine the impact of ziprasidone and olanzapine on QTc interval, weight and metabolic parameters in adults with schizophrenia and other psychoses. A retrospective cohort chart review was performed of 191 randomly selected patients who were being treated with ziprasidone or olanzapine in an integrated health care system. Significant differences on QTc interval were not observed. A significant weight gain was observed in olanzapine-treated patients (P<0.001) but not in the ziprasidone-treated cohort (P>0.05). Furthermore, adverse metabolic changes associated with olanzapine administration were significant with respect to effects on total cholesterol (P=0.01), triglycerides (P=0.05) and haemoglobin A1C (HbA1C) (P<0.05), whereas significant favourable metabolic effects were observed in ziprasidone-treated patients with regard to total cholesterol (P<0.05), low-density lipoprotein (LDL) (P<0.01), high-density lipoprotein (HDL) (P<0.05) and HbA1c (P<0.05). Our results suggest that these two atypical antipsychotics are safe and well tolerated from a cardiovascular standpoint, with no differences in QTc interval prolongation being observed. Olanzapine-treated patients exhibited significant weight increases, whereas ziprasidone-treated patients exhibited weight loss. Olanzapine treatment was also associated with significant adverse effect on patient's lipid profile and HbA1c. These adverse metabolic effects were not observed in ziprasidone-treated patients although favourable effects were observed with regard to effect on total cholesterol, LDL, HDL and HbA1c.     

An analysis of QTc prolongation with atypical antipsychotic medications and selective serotonin reuptake inhibitors using a large ECG record database

ABSTRACT

Background: This study evaluated the effects of atypical antipsychotic drugs and selective serotonin reuptake inhibitors (SSRIs) on the corrected QT (QTc) interval using a large database obtained from clinical settings. Additionally, the effects of factors including age on QTc intervals were estimated.

Methods: Using an open-access QT database (ECG-ViEW), QTc-lengthening effects of 14 selected atypical antipsychotics and SSRIs were compared to those of a positive control drug, cilostazol, and a negative control drug, diazepam. We also evaluated effects of age, sexgender, and select electrolyte levels on observed QTc intervals.

Results: The frequency of QTc prolongation with the pooled data of the 14 study drugs was lower than that with cilostazol (age-adjusted odds ratio (OR) = 0.43, 95% confidence interval (CI) = 0.27-0.69), but no significant difference was found relative to when compared with that with diazepam (age-adjusted OR = 0.89, 95% CI = 0.55-1.47). Furthermore, administration of the 14 study drugs significantly increased the QTc interval by 2.89 ms after each 10-year age increment (p-value < 0.0001).

Conclusions: This study suggests that atypical antipsychotic drugs and SSRIs are less likely to be associated with QTc prolongation in clinical settings. In addition, age showed a significant association with the QTc interval. Further studies with well-characterized cohorts are warranted.     

The potential relationship between QTc interval prolongation and ziprasidone treatment: three cases

QTc interval prolongation may appear as a consequence of both typical and atypical antipsychotic treatments. Ziprasidone, which is effective in treating schizophrenia, is associated with QTc prolongation. Although the prolongation of QTc with ziprasidone treatment is often pronounced, there is a scarce number of cases reported about the relationship between ziprasidone and QTc prolongation. Of the three cases presented in this case series, two cases showed values exceeding 0.50 s with ziprasidone treatment.     

左氧氟沙星对2型糖尿病合并感染患者的QTc间期影响*

目的：探讨左氧氟沙星治疗2型糖尿病合并感染时,对患者QTc（QT校正间期）的影响;并探求引起QTc变化的危险因素。方法：收集2015-2018年我院住院的2型糖尿病且有细菌性感染迹象给予左氧氟沙星治疗的患者一般资料、糖化血红蛋白、血糖、血脂、12导联心电图。共入选2型糖尿病合并细菌性感染病例182例,予治疗前及治疗7日后测定静息态心电图,计算QTc间期。结果与结论：在238例患者中,用药前有56例存在QTc间期延长,占比23.53%,在治疗后有94例存在QTc间期延长,占比39.49%,治疗后QTc间期延长发生率高于治疗前,两者存在统计学差异。治疗前平均QTc为0.41 s,治疗后平均QTc为0.43 s,整体延长4.87%,两者存在统计学差异。通过Logistic回归分析表明QTc间期延长与性别、年龄、是否合并糖尿病周围神经病变、糖化血红蛋白水平以及糖尿病病程相关,为糖尿病患者使用左氧氟沙星发生心律失常的危险因素。     

Long-term treatment with antipsychotic drugs in conventional doses prolonged QTc dispersion, but did not increase ventricular tachyarrhythmias in patients with schizophrenia in the absence of cardiac disease

Objective: The aim of this study was to examine the hypothesis that long-term treatment with antipsychotic drugs in conventional doses prolongs QTc dispersion and increases ventricular tachyarrhythmias in patients with schizophrenia in the absence of cardiac disease. Methods: We measured QTc and QTc dispersion and ventricular tachyarrhythmias in 64 patients with schizophrenia, including 59 patients who received psychiatric medications, and five patients who did not receive psychiatric medications, and 45 healthy volunteers. None of the subjects had a history of cardiac disease or showed any abnormality in chest radiograph and transthoracic echocardiographic studies. None of the subjects had electrolyte abnormality. None of the subjects were taking drugs known to influence the QT interval, other than psychiatric medications. Results: QTc and QTc dispersion were significantly (P < 0.017) increased in patients who received psychiatric medications compared with patients who did not receive psychiatric medications, or with healthy volunteers [QTc: 0.442 (0.029), 0.418 (0.029), 0.417 (0.028) s, QTc dispersion: 0.054 (0.013), 0.038 (0.017), 0.038 (0.009) s]. Daily ventricular premature beats were 183 (689), 77 (23), and 86 (149), respectively. No ventricular tachycardia was observed. There were no correlation between QTc and QTc dispersion and ventricular premature beats. Conclusion: Long-term treatment with antipsychotic drugs in conventional doses prolonged both QTc and QTc dispersion in patients with schizophrenia, but did not increase ventricular tachyarrhythmias in patients with schizophrenia in the absence of cardiac disease. However, despite the negative findings, ventricular tachyarrhythmias may occur as a rare side-effect of antipsychotic drugs, particularly if a patient has additional risk factors. Received: 28 September 1998 / Accepted in revised form: 27 January 1999     

Ziprasidone and the QTc interval: pharmacokinetic and pharmacodynamic considerations

Many psychotropic medications might cause prolongation of the QTc interval; however, antipsychotics have recently come under increasing scrutiny in this regard. Ziprasidone, a newly marketed second-generation antipsychotic, was initially delayed in approval by the FDA due to its propensity to prolong the QTc interval in patients with schizophrenia. While ziprasidone does prolong the QTc interval, safety, concomitant medication, and overdose data present little reason to consider ziprasidone a major risk factor for Torsades de Pointes thus far. The paucity of data regarding this agent, however, and its use in those with additional risk factors for QTc-interval prolongation are striking. The risk for this phenomenon has not been studied in patients with concomitant disease states that might be associated with QTc-interval prolongation or in those taking metabolic inhibitors which might inhibit aldehyde oxidase. Little is known about a major metabolic route of ziprasidone, oxidation by aldehyde oxidase. Finally, experience with other agents associated with QTc-interval prolongation raises the possibility that both the type and number of individuals studied to date might not be sufficient to reveal problems with ziprasidone. This paper will review the literature concerning real and theoretical implications of pharmacokinetic and pharmacodynamic interactions with ziprasidone, particularly with regard to these effects on the QTc interval.     

QTc variability in schizophrenia patients treated with antipsychotics and healthy controls

QTc prolongation is associated with the administration of some antipsychotics but the QTc interval is also known to vary physiologically. There is little published evidence about changes in QTc variability during treatment with antipsychotics. In this prospective investigation, we analyzed ECGs in 61 patients suffering from a schizophrenic disorder who were treated with different antipsychotics and 31 sex- and age-matched healthy controls. We found no differences in QTc intervals nor in QTc variability between patients and controls. Our results raise the question of the clinical relevance of a single ECG for diagnostics of cardiac complications in schizophrenia patients and suggest the need to conduct ECG monitoring in patients at high risk for cardiac complications during antipsychotic treatment.