利培酮、氯氮平的血药浓度对首发精神分裂症患者心肌酶和心电图的影响

Effects of Serum Concentrations of Risperidone and Clozapine on Myocardial Enzymes and Electrocardiogram in Patients with First-episode Schizophrenia

目的:了解抗精神病药物利培酮、氯氮平的血药浓度对首发精神分裂症患者心肌酶和心电图的影响。方法:选取2012年3月-2013年1月于本院住院的精神分裂症患者83例。按照治疗方法不同将其分为利培酮组47例(口服利培酮片),氯氮平组36例(口服氯氮平片)。于治疗第2、4、8周末及1、5年后分别监测患者的血药浓度、心肌酶(CK、AST、CK-MB)及心电图变化,并进行比较。结果:治疗第2、4、8周末及1年后,两组CK、CK-MB、AST均高于治疗前(P<0.05);治疗5年后,两组CK-MB与治疗前比较差异均无统计学意义(P>0.05),但CK、AST均高于治疗前(P<0.05);治疗第2、4、8周末及1年后、5年后,两组心电图的异常率均高于治疗前(P<0.05),其中最常见的心电图异常为窦性心动过速、窦性心动过缓、ST段改变,且氯氮平组比利培酮组更容易引起心电图的异常。结论:利培酮和氯氮平均可以导致精神分裂症患者心肌酶的升高,但是长期服用,随着氯氮平和利培酮血药浓度下降,CK-MB升高的比例会下降;服用利培酮和氯氮平后容易引起心电图的异常,最常见的是心动过速、心动过缓、ST段改变,氯氮平比利培酮更容易引起心电图的异常。

Objective:To investigate the effects of blood concentration of Risperidone and Clozapine on myocardial enzymes and electrocardiogram in patients with first-episode schizophrenia.Method:A total of 83 schizophrenic patients hospitalized in our hospital from March 2012 to January 2013 were selected.According to different treatment methods,they were divided into Risperidone group(n=47,oral Risperidone Tablets)and Clozapine group(n=36,oral Clozapine Tablets).The changes of serum drug concentration,myocardial enzymes(CK,AST,CK-MB)and electrocardiogram were monitored and compared at the 2nd,4th,8th weekend and 1,5 years after treatment.Result:At the 2 nd,4 th,8 th weekend and 1 year after treatment,the CK,CK-MB and AST in two groups were higher than those of before treatment(P<0.05),after 5 years of treatment,the CK-MB in two groups were compared with before treatment,the differences were not statistically significant(P>0.05),but the CK and AST were higher than those of before treatment(P<0.05).At the 2nd,4th,8th weekend and 1,5 years after treatment,the abnormal rate in two groups were higher than those of before treatment(P<0.05),the most common electrocardiographic abnormalities were sinus tachycardia,sinus bradycardia,ST segment changes,and clozapine group was more likely to cause electrocardiographic abnormalities than risperidone group.Conclusion:Risperidone and Clozapine can lead to the increase of myocardial enzymes in schizophrenic patients on average,but with the decrease of blood concentration of Clozapine and Risperidone for a long time,the proportion of CK-MB increases will decrease,after taking Risperidone and Clozapine,it is easy to cause abnormal ECG,the most common ones are tachycardia,bradycardia,ST segment changes,and Clozapine is more likely to cause ECG than Risperidone.