长期抗精神病药物单药或多药治疗对女性精神分裂症心率校正后的QT间期的影响

Effect of long-term antipsychotic single or multi-drug therapy on heart rate-corrected QT interval interval of female schizophrenia

目的探讨女性精神分裂症患者心脏根据心率校正后的QT间期(corrected QT interval,QTc)与长期抗精神病药物单药或多药治疗的关系。方法选取2016年1月至2018年12月在上海市精神卫生中心及上海市奉贤区精神卫生中心住院的女性精神分裂症患者60例,分为使用一种抗精神病药物组(单药组,n=20)和联合两种或以上抗精神病药物组(多药组,n=40),分别在基线期以及第3、6、12、18和24个月末检测心脏QTc,比较两组患者在不同时点的QTc差异,计算QTc延长的比例。结果所有患者各时间点QTc延长所占的比例为26.7%~46.7%。两组QTc延长比例在各个时点差异均无统计学意义(P>0.05)。多药组的QTc在不同时间点差异有统计学意义(P<0.05),且在第3、18及24个月QTc均超过440 ms,最大值在第18个月末。而单药组各个时间点QTc间期均未超过440 ms。从各时间点看,第18个月两组患者的QTc差异有统计学意义(P<0.05),在第3、6、12及24个月多药组QTc长于单药组,但差异无统计学意义(P>0.05)。结论女性精神分裂症患者,尤其是多药联用的女性患者在长期使用抗精神病药物期间应对其心脏QTc间期进行监测。

Objective To explore the relationship between heart rate-corrected QT interval(QTc)and long-term antipsychotic monotherapy or multidrug therapy in female patients with schizophrenia.Methods A total of 60 female schizophrenic patients hospitalized in Shanghai mental health center and in mental health center of Fengxian district of Shanghai from January 2016 to December 2018 were selected.The patients were divided into two groups.The single-drug group included the patients who took only one kind of antipsychotic(n=20),and the multi-drug other included the patients who took two or more kinds of antipsychotic(n=40).Cardiac QTc intervals were respectively measured at baseline,the third,6th,12th,18th and 24th months.The difference of QTc interval and the prolongation rate of QTc interval between two groups at different time points were compared.Results The rate of QTc interval prolongation was 26.7%~46.7%in all patients.There was no significant difference in the rate of QTc interval prolongation in single/multi-drug group at each time point(P>0.05).There was significant difference in multi-drug group at different time points(P<0.05).The QTc interval of the multi-drug group exceeded 440 ms at the third,18th and 24th month,and the maximum value was at the end of the 18th month in the multi-drug group.However,the QTc interval of the single drug group did not exceed 440 ms at each time point,and from the point of view of each time point.In the 18th month,there was significant difference in QTc interval between the two groups(P<0.05).The duration of QTc interval in the third,6th,12th and 24th months was longer in the multi-drug group than in the single-drug group(P>0.05).Conclusion QTc intervals should be monitored during long-term use of antipsychotic drugs in female patients with schizophrenia,especially in patients with multi-drug use.