氯氮平治疗精神性疾病所致心脏不良反应发生的危险因素分析  

Analysis of risk factors of adverse cardiac reactions caused by clozapine in the treatment of mental illness

作　　者：奚丽华 张红霞 黄惠珍 XI Li-hua;ZHANG Hong-xia;HUANG Hui-zhen(Psychiatry Department,the Second Mental Health Center of Shanghai Civil Administration,Shanghai 201319,CHINA;Nursing Department,the Second Mental Health Center of Shanghai Civil Administration,Shanghai 201319,CHINA)

机构地区：[1]上海市民政第二精神卫生中心精神科,上海201319 [2]上海市民政第二精神卫生中心护理部,上海201319

出　　处：《海南医学》2022年第4期424-427,共4页Hainan Medical Journal

摘　　要：目的分析氯氮平治疗精神性疾病所致心脏不良反应发生的危险因素。方法回顾性分析2018年6月至2020年6月上海市民政第二精神卫生中心收治的180例精神性疾病患者的临床诊治资料,所有患者均给予氯氮平治疗,根据患者是否发生心脏不良反应分为发生组31例和非发生组149例。比较两组患者的年龄、性别、吸烟史、体质指数(BMI)、合并基础病、氯氮平剂量、服用期间氯氮平血药浓度等资料,并采用多因素Logistic回归分析精神性疾病患者服用氯氮平致心脏不良反应发生的危险因素。结果发生组患者的血药浓度在350~600μg/L、>600μg/L的比例明显高于非发生组,差异均有统计学意义(P<0.05);发生组患者治疗前服用其他抗精神病药物、联合其他心血管药物治疗的比例明显高于非发生组,差异均有统计学意义(P<0.05);Logistic分析结果显示,氯氮平服药剂量>600 mg/d、血药浓度>600μg/L、治疗前服用其他抗精神病药物及联合应用其他抗精神病药物均为精神性疾病患者服用氯氮平心脏不良反应发生的危险因素(P<0.05)。结论精神性疾病患者大剂量服用氯氮平的心脏不良反应发生率较高,且受到的影响因素较多。应根据可能的危险因素采取相应的措施干预,提高用药安全性。Objective To analyze the risk factors of adverse cardiac reactions caused by clozapine in the treatment of mental illness.Methods The clinical diagnosis and treatment data of 180 patients with mental diseases treated in the Second Mental Health Center of Shanghai Civil Administration from June 2018 to June 2020 were retrospectively analyzed.All patients were treated with clozapine.According to whether the patients had adverse cardiac reactions,they were divided into 31 cases in the occurrence group and 149 cases in the non-occurrence group.The age,gender,smoking history,body mass index(BMI),combined basic diseases,clozapine dose,and clozapine plasma concentration during taking between the two groups were compared.The risk factors of adverse cardiac reactions caused by clozapine in patients with mental diseases were analyzed by multivariate Logistic regression.Results The proportions of blood drug concentration of 350-600μg/L,and>600μg/L in the occurrence group were significantly higher than those in the non-occurrence group,with statistically significant differences(P<0.05).The proportions of patients in the occurrence group taking other antipsychotics and combined with other cardiovascular drugs before treatment were significantly higher than those in the non-occurrence group(P<0.05).Logistic analysis showed that the dosage of clozapine>600 mg/d,blood concentration>600μg/L,taking other antipsychotics before treatment,and combined use of other antipsychotics were the risk factors of adverse cardiac reactions in patients with mental diseases(P<0.05).Conclusion Patients taking high-dose clozapine have a high incidence of cardiac adverse reactions,which are affected by many factors.Corresponding intervention measures should be taken according to possible risk factors to improve drug safety.

关 键 词：氯氮平 精神性疾病 心脏不良反应 服药剂量 危险因素 

分 类 号：R749[医药卫生—神经病学与精神病学]