抗抑郁药诱发低钠血症的危险因素分析  

Analysis on risk factors of hyponatremia induced by antidepressive agents

作　　者：王健[1] 鲍枫[1] 潘伟刚[1] 罗雪[1] 

机构地区：[1]首都医科大学附属北京安定医院精神科,100088

出　　处：《药物不良反应杂志》2015年第2期112-116,共5页Adverse Drug Reactions Journal

摘　　要：目的分析抗抑郁药诱发低钠血症的风险及相关危险因素。方法收集2009年1月至2010年12月在首都医科大学附属北京安定医院住院期间使用抗抑郁药患者的病历资料进行回顾性对照研究。低钠血症诊断标准为血清钠浓度＜135 mmol／L（轻、中、重度分别为131-＜135、120-130、＜120 mmol／L）。将住院期间至少1次检测显示血清钠浓度＜135 mmol／L的患者纳入低钠血症组，将第一次出现血钠浓度降低的检测日期定义为标定日期；血清钠浓度在135-144 mmol／L的患者纳入对照组，从低钠血症组患者标定日期＆#177;5 d范围内随机选取2或3例患者。比较2组患者的人口学特征、所患精神疾病、合并躯体疾病、标定日其他相关实验室检查指标、所用抗抑郁药种类及合并用药情况，应用多元Logistic回归方法对出现低钠血症的危险因素进行评估，结果以比值比（ OR）及其95％置信区间（ CI）表示。结果共214例患者纳入研究，低钠血症组58例，对照组156例。低钠血症组58例患者中出现轻、中和重度低钠血症者分别为38例（65.5％）、8例（13.8％）和12例（20.7％）。低钠血症组患者中年龄≥65岁、酒药依赖、使用选择性5-羟色胺再摄取抑制剂（ SSRI）者占比均明显高于对照组[65.5％（38／58）比37.8％（59／156），24.1％（14／58）比3.6％（6／156），69.0％（40／58）比38.5％（60／156），均P＜0.001]；合并肺部疾病以及联用抗癫痫药、利尿药或β受体阻滞剂者占比也明显高于对照组。多元Logistic回归分析显示，应用SSRI、年龄≥65岁、酒药依赖、联用抗癫痫药、利尿剂或β受体阻滞剂是患者出现低钠血症的危险因素[应用SSRI：χ2=8.336，OR=3.023，95％CI为1.02-9.67，P=0.001；年龄≥65岁：χ2=6.482，OR =2.911，95％CI 为1.36-9.06，P=0.032；酒药依赖：χ2=5.632，OR=2.428，95％CI为1.20-4.94，P=0.021；联用抗癫痫药：χObjective To analyze the risk of hyponatremia induced by antidepressant drugs and related risk factors. Methods Medical record data of patients who were treated with antidepressant drugs during hospitalization in Beijing Anding Hospital,Capital Medical University from January 2009 to December 2010 were collected and a retrospective controlled study was conducted. The blood sodium level 〈135 mmol/L was defined as hyponatremia（the levels of 131-〈135,120-130,and 〈120 mmol/L were defined as mild,moderate and severe hyponatremia,respectively）. The patients whose serum sodium levels were 〈135 mmol/L at lease one time during hospitalization were enrolled into the hyponatremia group. The detection day when the serum sodium level was 〈135 mmol/L for the first time was defined as calibration date. The patients whose serum sodium levels were from 135 to 144 mmol/L were enrolled into the control group. They were selected randomly before or after 5 days of calibration date. The demographic characteristics, psychiatric diseases, combined somatic diseases, related laboratory examinations, antidepressant drugs,and other concomitant drugs in patients in the 2 groups were compared. The risk factors related to hyponatremia were evaluated using Logistic regression analysis and the odds ratios（ OR） with 95% confidence intervals（95% CI）were calculated. Results A total of 214 patients were enrolled into the study. Of them,58 patients were in the hyponatremia group and 156 were in the control group. The numbers of patients with mild,moderate,and severe hyponatremia were 38（65. 5%）,8（13. 8%）,and 12（20. 7%）,respectively,among the 56 patients in the hyponatremia group. The percentages of patients≥65 years old,with alcohol or drug dependence,selective serotonin reuptake inhibitors（ SSRI）treatment in the hyponatremia group were higher than those in the control group[65. 5%（38/58）vs. 37. 8%（59/156）,24. 1%（14/58）vs. 3. 6%（6/156）,69. 0%（40/58）vs. 38. 5%（60/156）,all P〈0. 001]. Th

关 键 词：抗抑郁药 低钠血症 

分 类 号：R591.1[医药卫生—内科学]