精神分裂症与抑郁症患者视觉P300电位的随访比较

目的　探讨精神分裂症和抑郁症患者事件相关电位 (ERPs)P3 0 0 的P3 波异常的意义。方法　对 2 1例精神分裂症、15例抑郁症患者在未服药和停药半年后的发病期及 2年缓解期后采用视觉图像辨认作业引出中央点P3 0 0 ,并与 2 4名正常对照者进行比较。结果　两病例组在发病期P3 潜伏期 [精神分裂症组 (431± 42 )ms,抑郁症组 (40 5± 32 )ms]延长、波幅 [精神分裂症组 (4 7± 2 0 ) μV ,抑郁症组 (5 3± 2 7) μV]下降 ,与对照组 [(36 7± 13)ms、(9 3± 3 1) μV]间的差异有显著性 ;缓解期复查仅精神分裂症组P3 潜伏期 [(410± 30 )ms]及波幅 [(7 1± 3 3) μV]异常较明显 ,抑郁症组潜伏期[(374± 9)ms,波幅为 (8 1± 4 1) μV]与对照组间的差异无显著性。结论　精神分裂症P3 波异常具一定跨状态稳定性 ,其中潜伏期的延长更为稳定 ;而在抑郁症则与临床状态有关。     

强迫症、抑郁症及焦虑症患者事件相关电位的比较研究

目的　探讨强迫症 (OCD)、抑郁症 (CD)及焦虑症 (CA)患者三种事件相关电位 (ERP)的变异。方法　应用美国NicoletSpirit脑诱发电位仪 ,采用光和声成对刺激、反应时间以及听觉靶 非靶刺激序列技术 ,检测 31例OCD、2 0例CD和 17例CA及 2 8名正常人 (NC)的关联性负变 (CNV)、P3 0 0 及失匹性负波 (MMN)。结果　 (1)CNV :M1波幅CD组 [(5± 4 ) μV]和CA组 [(7± 4 ) μV]低于NC组 [(14±6 ) μV]和OCD组 [(16± 6 ) μV ;P <0 0 5和P <0 0 1]。指令信号后负变化的出现率CD组 (6 0 % )、OCD组 (45 % )和CA组 (35 % )均高于NC组 (4% ;P <0 0 1)。 (2 )P3 0 0 :在靶刺激中 ,N2 潜伏期在四组间的差异有非常显著性 (P <0 0 1) ,其中OCD组 [(2 78 9± 2 2 7)ms]和CD组 [(2 77 3± 2 1 8)ms]的潜伏期均长于NC组 [(2 5 9 0± 14 0 )ms],CA组短于CD组和OCD组 (P <0 0 1) ;P3 波幅在四组间的差异亦有非常显著性 (P <0 0 1) ,其中OCD组 [(3 4± 1 5 ) μV]、CD组 [(2 9± 1 3) μV]和CA组 [(3 3± 1 3) μV]均低于NC组 [(5 9± 2 1) μV]。在非靶刺激中 ,CA组P2 波幅低于OCD组和NC组 (P <0 0 5 )。 (3)MMN :OCD组、CD组及NC组之间潜伏期和波幅的差异有显著性和非常显著性 (P <0 0 5和P <0 0 1)。其中OCD     

情感性精神障碍感觉性诱发电位变异与自杀行为史的关联性研究

目的　探讨情感性精神障碍患者感觉性诱发电位 (SEP)变异与自杀行为史的关系及其临床意义。方法　应用美国尼高力公司Spirit脑诱发电位仪 ,检测 39例抑郁症 (抑郁症组 )患者、2 2例躁狂症 (躁狂症组 )患者和 33名正常对照者 (对照组 )的视觉诱发电位 (VEP)、听觉诱发电位 (AEP)和体感诱发电位 (SSEP) ,并对两患者组中有无自杀史者的测定结果进行比较。结果　 (1 )抑郁症组在VEP中的P2 潜伏期 [有自杀史者为 (2 1 1± 2 1 )ms,无自杀史者为 (2 0 9± 1 7)ms]长于正常对照组 [(1 94±1 9)ms;P <0 0 1和P <0 0 5]。 (2 )抑郁症组和躁狂症组SEP主成分的波幅均低于对照组。 (3)在VEP中 ,抑郁症组中有自杀史者的P3波幅 [(2 7± 1 8) μV]低于无自杀史者 [(5 5± 2 3) μV] ;躁狂症组中有自杀史者的P2 波幅 [(2 9± 1 8) μV]低于无自杀史者 [(5 5± 2 3) μV] ;在AEP中 ,躁狂症组中有自杀史者的P2 波幅 [(3 7± 1 9) μV]低于无自杀史者 [(5 1± 2 3) μV] ,差异有显著性和非常显著性 (P <0 0 5和P <0 0 1 )。结论　感觉性诱发电位是辅助评价自杀倾向的客观方法之一     

4种非经典抗精神病药对精神分裂症患者心电图校正QT间期的影响

目的评估利培酮、喹硫平、奥氮平、齐拉西酮4种非经典抗精神病药对精神分裂症患者心电图校正QT间期(corrected QT interval,QTc)的影响。方法 97例精神分裂症患者随机分为利培酮组(n=25)、喹硫平组(n=23)、奥氮平组(n=28)、齐拉西酮组(n=21),口服4种药物中的单一药物治疗。治疗前连续3次心电图检查,血药浓度达稳态后(1次常规服药前30分钟、估计Tmax、Tmax后60分钟)再连续3次心电图检查,测量QT间期,以Bazett’s公式校正为QTc。计算治疗前后QTc均值并进行比较。结果与治疗前相比,治疗后4组QTc都有延长,利培酮组[(382.4±16.3)ms vs.(378.6±13.9)ms]、奥氮平组[(379.2±15.6)ms vs.(376.7±15.13)ms]、喹硫平组[(382.8±16.9)ms vs.(377.5±14.3)ms]、齐拉西酮组[(402.4±33.8)ms vs.(377.1±14.6)ms],与治疗前比较差异有统计学意义(P<0.05)。治疗后QTc各组之间比较差异有统计学意义(P<0.05),齐拉西酮组延长最明显,其中1例女性患者QTc达534 ms。结论 4种非经典抗精神病药均不同程度延长精神分裂症患者QTc。     

精神分裂症院内康复措施及其疗效的一年随访

目的　探讨院内康复措施对精神分裂症患者的作用。方法　将 12 4例精神分裂症住院患者随机分为措施干预组和对照组 ,每组各 6 2例。在抗精神病药治疗的同时 ,对干预组施以小组工作制、院内职业康复的两种技能训练 ,共 10周。出院后随访 1年。用简明精神病评定量表 (BPRS)、住院病人护士观察量表 (NOSIE 30 )、社会功能缺陷筛选量表 (SDSS)和就业率等进行评估。结果　 (1)与入组时比较 ,住院期间干预组NOSIE 30各因素的变化值从住院的第 2周开始至第 10周均优于对照组(均P <0 0 1) ,且增分和减分的幅度逐渐增大。 (2 )出院时点与随访最后时点评分差值的比较 ,干预组的SDSS分 [(4 0± 2 7)分 ]、NOSIE 30积极因素分 [(- 2 4 8± 4 9)分 ]和消极因素分 [(8 9± 3 6 )分 ]均显著优于对照组 [分别为 (- 3 9± 1 9)分、(5 2± 5 0 )分和 (- 19 5± 5 9)分 ;均P <0 0 1～P <0 0 0 1];(3)干预组的复发率 (10 %)、再住院率 (3%)和再就业率 (4 1%)皆优于对照组 (分别为 6 9%、5 6 %和 13%,P =0 0 0 0 )。结论　院内康复措施对控制精神分裂症患者的病情、提高社会功能和再就业率 ,以及降低复发率和再住院率具有重要的作用。     

药物自我处置和症状自我监控技能训练对预防精神分裂症复发的作用初探

目的探讨药物自我处置和症状自我监控技能训练对降低精神分裂症患者复发和提高其药物依从性的作用.方法将133例痊愈的精神分裂症患者随机分为技能训练组(以下简称训练组;66例)和对照组(67例).对训练组患者分组进行技能训练,共20周,两组均有64例完成1年随访.每月评定1次简明精神病量表(BPRS),每天以自制的监护人及患者药物依从性评分表进行评分;每2个月测定1次氯氮平血浓度.结果(1)入组时与随访末次评定差值的比较,训练组的BPRS总分[(3.3±13.7)分]、漏服药次数[(-0.9±3.0)次]、监护人药物依从性评分[(-53.0±31.2)分]和氯氮平血浓度[(85.5±44.8)ng/ml],均优于对照组,分别为[(-19.2±21.7)分]、[(-9.5±5.9)次]、[(26.5±24.3)分]和[(199.1±85.0)ng/ml],均P＜0.001;(2)训练组的复发率(12%)和再住院率(3%)低于对照组(分别为52%和38%;P＜0.001);(3)Kaplan-Meier生存分析显示,训练组的复发和再住院累计生存率优于对照组(复发的log-rankx2=25.62,再住院的log-rankx2=25.49,均P＜0.001).结论两种技能训练能降低精神分裂症患者的复发并提高其药物依从性.     

慢性精神分裂症男性患者听觉刺激惊跳反射的初步研究

目的 探讨汉族人群精神分裂症患者是否存在听觉惊跳反射缺陷及抗精神病药的影响.方法 第1代药物组:服用第1代抗精神病药的慢性精神分裂症男性患者25例;氯氮平组:服用氯氮平的慢性精神分裂症男性患者25例;对照组:身体健康的男性25名;3组的年龄和受教育年限均匹配.对上述3组进行听觉刺激惊跳反射检测,并使用阳性和阴性症状量表(PANSS)评定精神分裂症患者的临床精神病理症状.结果 (1)第1代药物组惊跳反射的反应波幅(SR)[(553.6±516.9)mV]明显低于对照组[(942.0±447.3)mV,P=0.009],氯氮平组的SR[(755.9±439.4)mV]介于上述2组之间,但与2组间的差异均无统计学意义(P＞0.05);(2)第1代药物组惊跳反射的适应性(HAB)[(17.8±35.8)%]明显低于对照组[(44.9±28.9)%,P=0.027],氯氮平组的HAB[(22.9±34.1)%]介于上述2组之间,但与2组间的差异均无统计学意义(P＞0.05);(3)当时间间隔(LI)为120 ms时,第1代药物组的惊跳反射弱刺激抑制(prepulse inhibition,PPI)显著小于对照组(P=0.024),氯氮平组的PPI值介于上述2组之间,但与2组间的差异均无统计学意义(P＞0.05);LI为30 ms或60 ms时,3组间PPI的差异无统计学意义(P＞0.05);(4)第1代药物组和氯氮平组患者不同LI的PPI与其临床病理症状可能不存在相关(P＞0.05).结论 精神分裂症患者可能存在听觉惊跳反射弱刺激抑制的缺陷;氯氮平可能能部分改善精神分裂症患者对惊跳反射的脱抑制.     

颈动脉粥样硬化斑块及相关生化指标与脑梗死的关系

目的　探讨颈动脉粥样硬化斑块及其相关生化指标与脑梗死的关系。方法　对 6 5例脑梗死患者 (脑梗死组 )及 35例非脑梗死患者 (对照组 )分别进行彩色多普勒超声检测 ,并记录两组颈动脉粥样硬化斑块的部位、数目、性质和颈动脉内径 ;同时检测两组的血脂、血糖和纤维蛋白原等生化指标。结果　脑梗死组颈动脉粥样硬化斑块检出率、左右颈总动脉内径 [81 5 4 %、(7 4 3± 0 0 7)mm、(7 5 2± 0 6 0 )mm]与对照组[2 8 5 7%、(7 75± 0 10 )mm、(7 97± 0 75 )mm]比较差异均有显著性 (均P <0 0 5 )。粥样硬化斑块位于颈总动脉最多 (78 2 3% ) ,其次是颈总动脉分叉处 (14 5 2 % ) ,颈内动脉颅外段最少 (7 2 5 % )。斑块部位与脑梗死部位有显著同侧相关性 (P <0 0 5 ) ;脑梗死组三酰甘油 (TG) [(1 81± 0 12 )mmol/L]、餐后 2h血糖 [(9 2 2± 0 4 3)mmol/L]及纤维蛋白原 [(3 18± 0 0 7)mmol/L]也均显著高于对照组 [(1 39± 0 0 9)mmol/L、(8 2 0± 0 35 )mmol/L、(2 6 4± 0 14 )mmol/L](均P <0 0 5 ) ;脑梗死组中颈总动脉内径与TG有显著正相关性 (r=0 34,P <0 0 1) ,与高密度脂蛋白 (HDL)存在显著负相关 (r=- 0 2 5 ,P <0 0 5 )。结论　颈动脉粥样硬化斑块与脑梗死发生有密切关系 ,部分脂质     

精神分裂症患者与其健康同胞的注意和执行功能障碍的对照研究

目的　探讨精神分裂症患者及其健康同胞的注意、工作记忆 /执行功能的特点。方法对 5 0例精神分裂症患者 (患者组 )及其健康同胞 5 0名 (同胞组 ) ,以及 4 5名正常对照者 (正常对照组 )采用威斯康星卡片分类测验 (WCST)和持续操作测验 (CPT) ,评估注意、工作记忆 /执行功能。结果　(1)在WCST中 ,患者组及其同胞组的总测验次数 (分别为 83 4± 2 3 2和 74 1± 2 4 6 )、持续错误数 (分别为 2 5 8± 11 7和 2 2 8± 10 7)、随机错误数 (33 4± 19 2和 2 5 9± 17 1)均高于正常对照组 (分别为6 0 0± 2 1 6、14 8± 8 3和 18 1± 16 0 ;P <0 0 1)。 (2 )在CPT中 ,患者组的评分 [(2 8 4± 4 0 )分 ]低于同胞组 [(30 4± 2 3)分 ]和正常对照组 [(30 9± 2 8)分 ],而同胞组与正常对照组的差异无显著性(P >0 0 5 )。(3)患者组及其同胞组发生执行功能障碍 (分别为 2 9例和 2 5例 )和注意缺陷 (分别为 2 2例和 7例 )的例数均多于正常对照组 (分别为 9例和 4例 ;P <0 0 1) ,其中有工作记忆 /执行功能缺陷的精神分裂症患者 ,其同胞出现这一缺陷的比率 (6 6 % )高于无缺陷的精神分裂症患者的同胞 (2 8% )。(4)WCST中的持续错误数与文化程度呈负相关 (r =- 0 32 ,P <0 0 1) ,CPT与性别 (r=- 0 2     

第二代抗精神病药治疗首发精神分裂症患者QTc间期变化的相关因素分析

目的观察第二代抗精神病药(SGAs)利培酮、奥氮平、喹硫平、齐拉西酮、阿立哌唑治疗首发精神分裂患者,研究QTc间期变化及其相关因素。方法收集北京回龙观医院2013年6月至2015年10月入院的首发精神分裂症患者共157例,比较QTc间期在用药前后的变化,及其影响因素的相关性,药物对QTc间期的影响。结果用药后2个月及3个月患者的QTc增加较基线期比显著延长(P0.05)。5种不同SGAs与第2个月QTc间期变化没有相关性。所有可能的影响因素中只有所服抗精神病药物的剂量与QTc间期延长呈正相关(P=0.029)。结论使用第二代抗精神病药治疗发生QTc间期延长,并且是剂量相关的,与所服抗精神病药物种类无关,但得出这一结果可能受组间样本量差异太大的影响。     

精神疾病患者猝死前心电图分析

目的：探讨精神疾病患者猝死前心电图特征及其相关影响因素。方法：将临床诊断为心脏性猝死的49例患者作为猝死组；随机抽出同期住院的60例患者作为对照组。比较两组患者心电图特征，人口学资料以及临床特征。结果：猝死组心电图异常发生率显著高于对照组（P〈0．05），主要表现为窦性心动过速、室性期前收缩、QT间期延长、T波改变、ST段低平、U波或TU融合波、左束支传导阻滞（LBBB）。猝死组氯氮平使用率显著高于对照组（P〈0．05）。两组使用氯氮平者心电图异常率明显高于未使用氯氮平者（P〈0．05或P〈0．01）。猝死组高龄，兴奋状态，低血钾，肌酸激酶升高，心脑血管疾病的发生率均显著高于对照组（P均〈0．05）。结论：精神疾病患者猝死前大多心电图异常，多呈非特异性改变。高龄、使用氯氮平以及某些临床征象可能成为患者猝死的危险因素。     

精神科住院患者猝死的相关因素分析：一项病例对照研究

目的识别精神科住院患者猝死的潜在危险因素，为探讨如何进一步预防住院精神病患者的猝死提供依据。方法选取1987年1月至2006年12月在广州市精神病医院精神科住院期间发生猝死的患者作为猝死组，选取与猝死组同性别相同或相近年龄、入院时间及在猝死者猝死当日仍住院的非死亡病例作为对照组，进行1：1匹配的病例对照研究。结果共有47例住院精神病患者发生猝死，猝死发生率1．68‰，（95％CI 1．20‰～2．16‰）。与对照组相比，猝死组合并心血管疾病、QTc间期延长及联用抗精神病药物的情况较多，差异有统计学意义（均P〈0．05）。结论对住院精神病患者的猝死危险评估和预防时要充分考虑其发生猝死的相关因素。     

Sudden cardiac death in diabetes mellitus: risk factors in the Rochester diabetic neuropathy study

OBJECTIVES: To determine risk factors for sudden cardiac death and the role of diabetic autonomic neuropathy (DAN) in the Rochester diabetic neuropathy study (RDNS). METHODS: Associations between diabetic and cardiovascular complications, including DAN, and the risk of sudden cardiac death were studied among 462 diabetic patients (151 type 1) enrolled in the RDNS. Medical records, death certificates, and necropsy reports were assessed for causes of sudden cardiac death. RESULTS: 21 cases of sudden cardiac death were identified over 15 years of follow up. In bivariate analysis of risk covariates, the following were significant: ECG 1 (evolving and previous myocardial infarctions): hazard ratio (HR) = 4.4 (95% confidence interval (CI), 1.6 to 12.1), p = 0.004; ECG 2 (bundle branch block or pacing): HR = 8.6 (2.9 to 25.4), p<0.001; ECG 1 or ECG 2: HR = 4.2 (1.3 to 13.4), p = 0.014; and nephropathy stage: HR = 2.1 (1.3 to 3.4), p = 0.002. Adjusting for ECG 1 or ECG 2, autonomic scores, QTc interval, high density lipoprotein (HDL) cholesterol, 24 hour microalbuminuria, and 24 hour total proteinuria were significant. However, adjusting for nephropathy, none of the autonomic indices, QTc interval, HDL cholesterol, microalbuminuria, or total proteinuria was significant. At necropsy, all patients with sudden cardiac death had coronary artery or myocardial disease. CONCLUSIONS: Sudden cardiac death was correlated with atherosclerotic heart disease and nephropathy, and to a lesser degree with DAN and HDL cholesterol. Although DAN is associated with sudden cardiac death, it is unlikely to be its primary cause.     

抗精神病药致首发精神疾病QTc 间期变化的相关 因素分析

目的 调查抗精神病药致首发精神疾病QTc间期延长的影响因素.方法 对服用稳定剂量抗精神病药治疗1月的309例首发精神疾病患者进行回顾性调查,收集人口学资料、空腹血糖、血压、血脂等生化指标、心电图资料,以QTc≥440ms作为QTc间期延长的标准,分析QTc间期延长的状况及其相关因素.结果 QTc间期延长的发生率为10.6%.药物治疗组QTc间期均值大于基线期,差异有统计学意义(P<0.05);药物联合电休克治疗组以及药物联合脑电治疗组QTc间期与基线期相比,差异无统计学意义(P>0.05).单一抗精神病药治疗组QTc间期与基线期差异无统计学意义(P>0.05);而抗精神病药联用以及抗精神病药联用抗抑郁药/心境稳定剂组QTc间期均值大于基线期,差异有统计学意义(P<0.05).抗精神病药等效氯丙嗪剂量<1000mg/d组别QTc间期与基线期相比差异有统计学意义(P<0.05).抗精神病药剂量与QTc间期没有相关性.女性是QTc间期延长的风险因素(OR=3.26,95%CI=1.050~10.094),其他因素未进入回归方程.结论 首发精神疾病患者抗精神病药治疗期间QTc间期延长存在性别差异,女性发生QTc间期延长的风险是男性的3.26倍.药物联用延长的QTc间期并未达到异常值.抗精神病药剂量与QTc间期没有相关性.除了性别因素外,其他指标不是QTc间期延长的风险因素.     

Antipsychotics and QT prolongation

OBJECTIVE: To evaluate literature relating to cardiac QT prolongation and the use of antipsychotic drugs. METHOD: Literature searches of EMBASE, Medline, PsychLIT were performed in December 2001 and reference sections of retrieved papers scrutinized for further relevant reports. RESULTS: The Cardiac QTc interval is difficult to measure precisely or accurately but appears to be a useful predictor of risk of dysrhythmia (specifically torsade de pointes) and sudden death. It is less clear that drug-induced QTc prolongation gives rise to similar risks but data are emerging, linking antipsychotic use to increased cardiac mortality. Many antipsychotics have been clearly associated with QTc prolongation. Methodological considerations arguably preclude assuming that any antipsychotic is free of the risk of QTc prolongation and dysrhythmia. CONCLUSION: Available data do not allow assessment of relative or absolute risk of dysrhythmia or sudden death engendered by antipsychotics but caution is advised. Risk of dysrhythmia can very probably be reduced by careful prescribing of antipsychotics in low doses in simple drug regimens which avoid metabolic interactions. Electrocardiographic monitoring may also help to reduce risk but review by specialist cardiologist may be necessary.     

Prolonged QT interval in acute psychotic patients

Some recent clinical studies indicate that hypokalemia is characteristic for acute psychotic patients at the time of emergency admission. As hypokalemia is one of the major causes for prolonged QT interval, it was hypothesized that acute psychotic patients could show prolonged QT interval. Sixty-seven drug-free, acute psychotic patients were evaluated for corrected QT (QTc) interval, as well as demographic and clinical characteristics at the time of emergency admission. The mean QTc interval of psychiatric emergency patients was prolonged, and the mean QTc interval of psychiatric emergency patients was longer than that of psychiatric outpatients (t=5.20, P<0.0001). Age- or gender-related difference, circadian fluctuation of QT interval, medication, concomitant disease, obesity, and serum electrolytes except potassium were not major causes. There was a significant negative correlation as evidenced by a coefficient of correlation of -0.28 (P<0.05). As psychiatric emergency patients often receive parenteral antipsychotics, which may have adverse effects on prolonged QT interval, paying attention to QT interval might have some clinical significance on emergency admission.     

精神分裂症患者QTc问期延长的影响因素

目的 调查精神分裂症患者心电图QTc间期延长及相关影响因素。方法 对服用稳定剂量抗精神病药的522例住院精神分裂症患者进行横断面调查,收集人口学资料,测定空腹血糖等生化指标,并进行心电图检查,以QTc≥440ms作为QTc间期延长标准,分析QTc间期延长状况及其相关因素。结果 QTc间期延长发生率12．8％,女性（22．7％）高于男性（7．8％）,差异有统计学意义（P〈0．01）,心电图窦性心动过速和传导阻滞患者QTc间期延长风险分别是心电图正常患者的2．6和3．1倍（P〈0．05）。结论 抗精神病药治疗期间QTc间期延长发生率存在性别差异,女性QTc间期延长的风险可能更高。     

Corrected QT intervals in newly admitted geriatric psychiatric patients: an examination of risk factors.

OBJECTIVES: The primary objective of this study was to determine the incidence of prolonged corrected QT (QTc) intervals in a population of geriatric psychiatry inpatients. Our secondary objective was to examine the associations between prolonged QTc intervals and risk factors identified as determinants in prolonging the QTc interval. METHODS: We identified all geriatric patients (aged 60 years and older) who were admitted to the geriatric program of our facility between May 1, 2003, and December 31, 2003. Those patients with a heart rate QTc interval calculated on the electrocardiogram (ECG) were eligible for the study. We used Bazett's formula to calculate the QTc interval. We defined a priori that a prolonged QTc interval would be 450 ms and 460 ms for men and women, respectively. We collected data on demographic variables such as weight, sex, age, and Axis I and III diagnoses, as well as on recognized risk factors for prolonged QTc interval. We used Student's t tests to conduct parametric analysis on continuous variables, and chi-square to test categorical variables for independence. RESULTS: During the study period, 88 patients were admitted to the geriatric division of Riverview Hospital. Of these patients, 34 men and 42 women had calculated QTc intervals on their ECG and therefore made up the study population. Our data show that 29.4% of men and 21.4% of women had prolonged QTc intervals. However, neither diagnostic nor medicinal risk factors were found to be associated with an increased incidence of prolonged QTc interval in this patient population. CONCLUSION: The preliminary findings of this study suggest that in this patient population the QTc interval may not be influenced by recognized risk factors to the same extent as observed in the adult population. These results warrant confirmation by a larger, prospectively designed study.     

Abnormalities of rate-corrected QT intervals in Parkinson's disease-a comparison with multiple system atrophy and progressive supranuclear palsy

A number of patients with Parkinson's disease (PD) and multiple system atrophy (MSA), in whom sudden death does occur occasionally, have QT or rate-corrected QT (QTc) interval prolongation on electrocardiogram (ECG). Although these QT or QTc interval abnormalities are likely related to autonomic dysfunction, the pathophysiology remains unknown. The aim of this study was to compare the degree of QTc interval prolongation among akinetic-rigid syndromes, namely PD and related disorders, and to evaluate the relationship between QTc prolongation and severity of autonomic dysfunction. Thirty-four patients with PD, 22 with MSA, 11 with progressive supranuclear palsy (PSP) and 30 healthy controls underwent standard autonomic function tests, and electrocardiography variables (RR, QT and QTc intervals) were measured by an ECG recorder with an automated analyzer. The relationship between QTc interval and cardiovascular reflex tests were also analyzed. Orthostatic hypotension and decreased heart rate in response to respiratory stimuli were prominent in MSA, while these were relatively mild in PD. Unlike the RR and QT intervals, the QTc interval significantly differed among all groups (p<0.01). The QTc interval was significantly prolonged in PD (409+/-17 ms; p<0.001) and MSA (404+/-14 ms; p<0.05) compared with healthy controls (394+/-19 ms). Neither autonomic dysfunction nor QTc interval prolongation was evident in PSP. QTc intervals and cardiovascular reflexes did not correlate, except for Valsalva ratio. The QTc interval was obviously prolonged in PD patients to an extent that could not be accounted for simply by autonomic dysfunction levels. MSA patients showed slightly prolonged QTc intervals in spite of marked cardiovascular autonomic dysfunction. Abnormalities of the QTc may reflect the degeneration of cardioselective sympathetic and parasympathetic neurons that cannot be fully captured by cardiovascular autonomic function tests.     

Prolonged Corrected QT Interval in Patients with Myotonic Dystrophy Type 1

Background and Purpose

Sudden cardiac death is one of the leading causes of death in patients with myotonic dystrophy type 1 (DM1). It has been proposed that a prolonged QT interval is associated with sudden cardiac death in several neurological diseases, including multiple system atrophy, idiopathic Parkinson''s disease, and diabetic autonomic neuropathy. However, analyses of the corrected QT (QTc) interval in DM1 patients are rare in the literature. The purposes of this study were to determine the association between the QT interval and DM1, and the affecting factors.

Methods

Thirty-nine patients diagnosed with DM1 through genetic testing were enrolled. The QTc interval (calculated using Bazett''s formula: QTc=QT/√RR) was compared between these patients and 39 normal healthy controls. The clinical and laboratory factors affecting QTc interval in the patient group were investigated.

Results

The QTc interval was significantly longer in the DM1 group (411.2±44.7 msec, mean±SD) than in the normal control group (355.6±20.6 msec). Intragroup analysis revealed that a prolonged QTc interval in DM1 patients was associated with being female and older, having a longer disease duration, and exhibiting abnormal electrocardiography findings.

Conclusions

The higher incidence of sudden cardiac death in the DM1 population is associated with the observed prolonged QTc interval in those patients.