Study on the Influence of Second Generation Antipsychotics on QTc Interval Prolongation in Patients with Schizophrenia

第二代抗精神病藥物對國人心電導延長影響研究

黃湘雄(Hsiang-Hsiung Huang) ； 黃湘萍(Hsiang-Ping Huang) ； 黃尚堅(Shang-Chien Huang)

《童綜合醫學雜誌》 4卷2期 (2010/12) Pp. 70-74

https://doi.org/10.29838/TMJ.201012.0003

摘要

目的：心電導延長(QTc interval prolongation)是抗精神病藥物在治療使用上的一個關注焦點，它可能導致多形性心室心搏過速(polymorphoric ventricular tachycardia, or torsade de pointes)，而出現致命的危險性。本研究希望能進一步了解第二代抗精神病藥物對國人心電導延長之影響。
方法：64位無心臟及中風病史之精神分裂症患者，使用第二代抗精神病藥物治療，在使用前及使用半年後給予心電圖檢查。統計方法為平均數差異檢定及變異數分析。
結果：全體個案用藥後QTc平均為420毫秒，均小於500毫秒。全數病患在使用第二代抗精神病藥物前後QTc平均延長10.8毫秒，並呈現顯著差異。以個別藥物而言，用藥前後QTc呈現顯著差異的是Quetiapine 13.3毫秒及Clozapine 23.8毫秒，其餘三者未呈現顯著差異。在不同藥物相互比較方面，Clozapine對QTc之影響顯著高於Risperidone，其餘未呈現顯著差異。
結論：研究結果顯示在第二代抗精神病藥物用藥後，雖QTc皆未達500毫秒，但部份藥物對QTc有顯著影響。臨床醫師在開立處方時，如遇有心臟疾病患者或併用其他可能影響QTc藥物時，仍應審慎為之。

並列摘要

Purpose: QTc interval prolongation is a focus of attention in application of antipsychotics as it may induce polymorphoric ventricular tachycardia, or torsade de pointes, and cause fatal risk. This study aims to investigate the influence of second generation antipsychotics on QTc interval prolongation for Taiwanese patients with schizophrenia.
Method: A total of 64 schizophrenic patients without heart disease and stroke history were recruited and treated with second generation antipsychotics. An electrocardiogram examination was provided to them before and half year after the treatment respectively. The data were statistically evaluated using comparison of means and analysis of variances.
Result: Average QTc of all of the patients after medication was 420ms, no more than 500ms. QTc of the patients prolonged in an average of 10.8ms and presented significant variances after they took the second generation antipsychotics. In terms of individual drugs, Quetiapine (13.3ms) and Clozapine (23.8ms) caused significant variances in QTc; but the remaining three drugs didn’t pose any notable variance. In comparison, Clozapine posed a remarkably greater effect on QTc than Risperidone and the remaining drugs didn't create any significant variance.
Conclusion: Findings of this study indicated QTc intervals of all of the patients after medication were no more than 500ms; however some drugs still created significant influences on QTc. Clinically, physicians should be cautious in prescribing for schizophrenia patients with heart disease or using drugs that may affect QTc together with antipsychotics.

並列關鍵字

QTc prolongation ； Antipsychotics ； Schizophrenia