喹硫平致库欣综合征患者血清皮质醇水平下降的临床药效学研究

Quetiapine Induced Cortisol Levels Decrease in One Patient and Related Literature Review

目的评价喹硫平降低库欣综合征患者血清皮质醇水平的有效性。方法通过一例库欣综合征患者应用喹硫平后血清皮质醇和促肾上腺皮质激素(ACTH)水平的变化,并对喹硫平致皮质醇水平降低的相关文献进行检索分析,分析喹硫平降低皮质醇水平的机制。结果 1例44岁男性库欣综合征患者睡前服用喹硫平0.05 g后血清皮质醇水平(8am)由34.73μg·d L^(-1) 降至5.68μg·d L^(-1) ,并于喹硫平停药1 d后回升至22.96μg·d L^(-1) ;ACTH水平由用药前99.2 pg·m L^(-1) 降至74.3 pg·m L^(-1) 。查阅文献喹硫平致皮质醇水平降低的有7项研究,均以精神病患者或健康受试者为研究对象,血清皮质醇水平降幅在6.9~2.7μg·d L^(-1) 。结论喹硫平可以降低精神病患者与库欣综合征患者以及健康人群的皮质醇水平。笔者对pumed、EMbase等数据库检索,均未见相关报道,本例是笔者检索到的首例喹硫平降低库欣综合征患者的血清皮质醇水平的病例报道。

OBJECTIVE To evaluate the efficacy of quetiapine in reducing serum eortisol levels in patients with Cushing＇s syn- drome. METHODS The change of serum cortisol and ACTH levels in one patient with Cushing syndrome treated by quetiapine was introduced, the related literature was reviewed, and the mechanism of quetiapine for reducing cortisol levels was analyzed. RESULTS One 44-year-old male patient with Cushing＇s syndrome took quetiapine 0.05 g for insomnia before bedtime. His cortisol level decreased from 34.73 to 5.68 μg·dL-1, and ACTH level decreased from 99. 2 to 74. 3 μg·dL-1. In the literature review, there were 7 reports of quetiapine-induced cortisol level decrease, all of the subjects were patients with mental illness or healthy subjects, and the serum cor- tisol levels were decreased at the magnitudes of 6. 9 - 2.7 g·dL-1. CONCLUSION Quetiapine can reduce cortisol levels of patients with mental illness and Cushing syndrome and healthy volunteers. As shown by literature searching through PubMed, EMbase and other databases, this case is the first report on quetiapine reducing serum cortisol levels of patients with Cushing＇s syndrome in the world.