氨磺必利与氯氮平、阿立哌唑对精神分裂症患者心肌酶和心电图影响的对比研究

A control study of influence of amisulpride,clozapine and aripiprazole on electrocardiogram and serum levels of myocardial enzymogram in patients with schizophrenia

目的比较氨磺必利与氯氮平、阿立哌唑对精神分裂症患者心肌酶和心电图的影响。方法将180例精神分裂症患者随机分为服用氨磺必利治疗60例(氨磺必利组)、氯氮平治疗60例(氯氮平组)、阿立哌唑治疗60例(阿立哌唑组),在治疗前及治疗后第2、4、8、12周末分别进行心肌酶和心电图的检测。结果 (1)治疗后第8周末阿立哌唑组AST水平高于治疗前(P<0.05),氨磺必利组CKMB和LDH高于治疗前(P<0.05);三组CK、α-HBDH在治疗后第4、8、12周末均高于治疗前(P<0.05)。(2)治疗后第12周末三组间T波异常发生率的差异有统计学意义(P<0.05),氯氮平T波异常例数高于氨磺必利组和阿立哌唑组(P<0.05)。(3)治疗后第12周末三组心电图异常率的差异有统计学意义(P<0.01),氯氮平组心电图异常率明显高于氨磺必利组和阿立哌唑组(P<0.05)。组内比较,氨磺必利组和阿立哌唑组在治疗后第12周末心电图异常率分别低于本组治疗后第2周末时(P<0.05)。结论氨磺必利、氯氮平、阿立哌唑对精神分裂症患者心肌酶和心电图均有一定影响,但氯氮平对心电图影响更为显著,治疗时间越长,对心脏不良影响越大。

Objective To study the influence of amisulpride,clozapine and aripiprazole on electrocardiogram and serum levels of myocardial enzymogram in patients with schizophrenia.Methods 180 schizophrenic patients were randomly divided into amisulpride group （n =60）,clozapine group （n =60）and aripiprazole group （n =60）treated with amisulpride,clozapine and aripiprazole respectively.The electrocardiogram and serum levels of myocardial enzymogram including AST,CK,CK-MB, LDH,α-HBDH were measured at baseline and at the end of the 2nd ,4th ,8th and 12th week of the treatment.Results （1）At the end of the 8th week,serum level of AST in aripiprazole group,as well as serum levels of CK-MB and LDH in amisulpride group were significantly higher than those at baseline （P 〈0.05 ）.Serum levels of CK and α-HBDH in 3 groups were significantly higher at the 4th,8th and 12th week of the treatment than those at baseline （P 〈0.05）.（2）There was significant difference in incidence of abnormal T wave among 3 groups at the 12th week （P 〈0.05）.The incidence of abnormal T wave in clozapine group was significantly higher than that in amisulpride group and aripiprazole group （P 〈0.05）.（3）The incidence rate of abnormal electrocardiogram showed significant difference among 3 groups at the 12th week （P 〈0.01 ）,and was significantly higher in clozapine group than that in amisulpride group and aripiprazole group （P 〈0.05）.Inner-group comparison showed that incidence rates of abnormal electrocardiogram in amisulpride group and aripiprazole group were significantly lower at the end of the 12th week than that at the end of the 2nd week respectively （P 〈0.05）.Conclusion Amisulpride,clozapine and aripiprazole can cause a certain adverse effects on electrocardiogram and myocardial enzymogram in patients with schizophrenia. The influence on electrocardiogram is relatively more obvious in clozapine treated patients and is likely to be more serious with the progress of treatment.