四种非典型抗精神病药长期治疗老年慢性精神分裂症对QTc间期的影响

Effects of four kinds of second-generation antipsychotics on QTc intervals in elderly chronic schizophrenia patients

目的评价利培酮、喹硫平、奥氮平和氯氮平四种非经典抗精神病药对老年慢性精神分裂症患者QTc间期的影响。方法将北京市海淀区精神卫生防治院2010年1月～2013年1月收治的80例老年慢性精神分裂症患者分为利培酮组（n=20）、奥氮平组（n=20）、喹硫平组（n=20）和氯氮平组（n=20）,接受单一药物治疗,随访1年。基线和治疗每月末分别检查心电图和血清钾钠氯水平。结果治疗12个月末,利培酮组、奥氮平组、喹硫平组和氯氮平组QTc间期分别延长了21.5、15.5、27.5、13.5 ms,四组QTc间期变化比较差异无统计学意义（F=2.18,P=0.097）。治疗1年内,四组精神分裂症患者均未达到QTc间期延长的诊断标准（男性〉470 ms,女性〉480 ms）,无任何患者QTc间期在原基础上增加超过60 ms。结论利培酮、奥氮平、奎刘平和氯氮平均具有延长QTc间期的作用,并且程度不同,但它们总体对QTc间期的影响有限,比较适合在老年慢性精神分裂症患者中使用。

Objective To evaluate the side effect of Risperidone, Olanzapine, Quetiapine and Clozapine on QTc interval in the treatment of elderly chronic schizophrenia patients. Methods Totally 80 schizophrenic patients admitted to Haidian Menta Health Hospital of Beijing from January 2010 to January 2013 were divided into Risperidone group（n =20）, Olanzapine group（n = 20）, Ouetiapine group（n = 20） and Clozapine group（n = 20）, all patients received single treatment, followed-up for 1 year. Electrocardiogram（ECG）, serum potassium, serum sodium and chloride levels examinations were measured at every month. Results At the end of 12 month, the changes of QTc interval were 21.5, 15.5,27.5, 13.5 ms in Risperidone, Olanzapine, Quetiapine and Clozapine group（F = 2.18, P = 0.097）. In one year followup of patients, no patient＇s QTc interval was increased to 470 ms in male patients or 480 ms in female patients. No patient＇s QTc interval was increased more than 60 ms on primary basis. Conclusion Risperidone, Olanzapine, Quetiapine and Clozapine can prolong the QTc interval to some degree, especially clozapine. But effects of four antipsychotics on QTc interval are all limited. It suggests that Risperidone, Olanzapine, Quetiapine and Clozapine on QTc interval quetiapine are safe in the management of elderly chronic schizophrenic patients.