정신신체의학 (Korean Journal of Psychosomatic Medicine)

한국정신신체의학회 (Korean Psychosomatic Society)
권호 표지
DOI QR코드

DOI QR Code

조현병 환자에서 QTc 간격연장에 관련되는 요인 : 후향적 연구

Clinical Correlates of QTc Prolongation in Patients with Schizophrenia : A Retrospective Study

  • 이정석 (국민건강보험 일산병원 정신건강의학과) ;
  • 박재섭 (국민건강보험 일산병원 정신건강의학과) ;
  • 박선영 (국민건강보험 일산병원 정신건강의학과)
  • Lee, Jung Suk (Department of Psychiatry, National Health Insurance Service Ilsan Hospital) ;
  • Park, Jaesub (Department of Psychiatry, National Health Insurance Service Ilsan Hospital) ;
  • Park, Sunyoung (Department of Psychiatry, National Health Insurance Service Ilsan Hospital)
  • 투고 : 2021.01.05
  • 심사 : 2021.03.29
  • 발행 : 2021.06.30
PDF 다운로드
⟨ 이전 논문 다음 논문 ⟩

초록

연구목적 항정신병약물로 인한 QTc간격연장은 심각한 심실성 부정맥을 초래할 가능성 때문에 주의가 필요한 부작용이다. 하지만 현재까지 국내에서 항정신병약물에 의한 QTc간격연장에 대한 연구는 많지 않았다. 본 연구는 조현병 환자에서 QTc간격연장에 영향을 주는 인구학적 및 임상적 변수를 알아보고자 한다. 방 법 일 병원에 입원치료를 받았던 441명 조현병 환자들의 의무기록을 후향적으로 검토하여 QTc간격과 인구학적 및 임상적 변수들을 파악하였다. QTc간격에 영향을 주는 변수를 알아보기 위해 QTc간격을 종속변수로 하여 위계적 중다회귀분석을 수행하였다. 결 과 평균 QTc간격은 417.2±28.4 ms였다. 위계적 중다회귀분석 결과 항정신병약물 단기작용주사제의 사용이 QTc간격연장의 가장 강한 예측인자였다. 결 론 본 연구는 조현병 환자에서 항정신병약물 단기작용주사제 사용이 QTc간격연장에 영향을 줄 수 있으며 조현병 환자의 치료 시 항정신병약물 단기작용주사제 사용에 보다 주의를 기울여야 함을 시사한다.

Objectives : QTc prolongation due to antipsychotics is of major concern because it may lead to fatal ventricular arrhythmia such as torsade de pointes. However, few studies have been conducted on QTc prolongation due to antipsychotics, especially in South Korea. This study aimed to investigate how demographic and clinical variables affect QTc interval in patients with schizophrenia. Methods : By retrospectively reviewing medical records, we assessed QTc interval, demographic data and clinical features of 441 (175 males) patients with schizophrenia who admitted to the psychiatric ward of a general hospital. To explore the predictive factors for QTc interval, hierarchical regression analysis was performed with QTc interval as the dependent variable. Results : The mean QTc interval was 417.2±28.4 ms. In the hierarchical regression analysis, the use of short-acting antipsychotic injection was the strongest predictor of the QTc prolongation. Conclusions : This study demonstrated that the use of short-acting antipsychotic injection may affect QTc prolongation in patients with schizophrenia. This result suggests that more attention should be paid to the use of short-acting antipsychotic injection in the treatment of schizophrenia.

키워드

과제정보

본 연구는 국민건강보험 일산병원의 연구비 지원으로 이루어졌음(NHIMC2019CR004).

참고문헌

  1. Stollberger C, Huber JO, Finsterer J. Antipsychotic drugs and QT prolongation. Int Clin Psychopharmacol 2005;20:243-251. https://doi.org/10.1097/01.yic.0000166405.49473.70
  2. Vieweg WV. New generation antipsychotic drugs and QTc interval prolongation. Prim Care Companion J Clin Psychiatry 2003;5:205-215. https://doi.org/10.4088/PCC.v05n0504
  3. Vandael E, Vandenberk B, Vandenberghe J, Willems R, Foulon V. Risk factors for QTc-prolongation: systematic review of the evidence. Int J Clin Pharm 2017;39:16-25. https://doi.org/10.1007/s11096-016-0414-2
  4. Leucht S, Cipriani A, Spineli L, Mavridis D, Orey D, Richter F, Samara M, Barbui C, Engel RR, Geddes JR, Kissling W, Stapf MP, Lassig B, Salanti G, Davis JM. Comparative efficacy and tolerability of 15 antipsychotic drugs in schizophrenia: a multiple-treatments meta-analysis. Lancet 2013;382:951-962. https://doi.org/10.1016/S0140-6736(13)60733-3
  5. Takeuchi H, Suzuki T, Remington G, Uchida H. Antipsychotic polypharmacy and corrected QT interval: a systematic review. Can J Psychiatry 2015;60:215-222. https://doi.org/10.1177/070674371506000503
  6. Sala M, Vicentini A, Brambilla P, Montomoli C, Jogia JR, Caverzasi E, Bonzano A, Piccinelli M, Barale F, De Ferrari GM. QT interval prolongation related to psychoactive drug treatment: a comparison of monotherapy versus polytherapy. Ann Gen Psychiatry 2005;4:1. https://doi.org/10.1186/1744-859X-4-1
  7. Park SC, Lee MS, Kang SG, Lee SH. Patterns of antipsychotic prescription to patients with schizophrenia in Korea: results from the health insurance review & assessment servicenational patient sample. J Korean Med Sci 2014;29:719-728. https://doi.org/10.3346/jkms.2014.29.5.719
  8. American Psychiatric Association. Diagnostic and statistical manual of mental disorders, fourth edition, text revision. Washington, DC: American Psychiatric Association;2000.
  9. Inada T, Inagaki A. Psychotropic dose equivalence in Japan. Psychiatry Clin Neurosci 2015;69:440-447. https://doi.org/10.1111/pcn.12275
  10. Yang FD, Wang XQ, Liu XP, Zhao KX, Fu WH, Hao XR, Zhang XL, Huang GS, Qu SC, Bai JS, Huang XF, Kosten TR, Zhang XY. Sex difference in QTc prolongation in chronic institutionalized patients with schizophrenia on long-term treatment with typical and atypical antipsychotics. Psychopharmacology (Berl) 2011;216:9-16. https://doi.org/10.1007/s00213-011-2188-5
  11. Harvey AT, Flockhart D, Gorski JC, Greenblatt DJ, Burke M, Werder S, Preskorn SH. Intramuscular haloperidol or lorazepam and QT intervals in schizophrenia. J Clin Pharmacol 2004;44:1173-1184. https://doi.org/10.1177/0091270004267807
  12. Miceli JJ, Tensfeldt TG, Shiovitz T, Anziano R, O'Gorman C, Harrigan RH. Effects of Oral Ziprasidone and Oral Haloperidol on QTc interval in patients with Schizophrenia or Schizoaffective disorder. Pharmacotherapy 2010;30:127-135. https://doi.org/10.1592/phco.30.2.127
  13. Miceli JJ, Tensfeldt TG, Shiovitz T, Anziano RJ, O'Gorman C, Harrigan RH. Effects of high-dose ziprasidone and haloperidol on the QTc interval after intramuscular administration: a randomized, single-blind, parallel-group study in patients with schizophrenia or schizoaffective disorder. Clin Ther 2010;32:472-491. https://doi.org/10.1016/j.clinthera.2010.03.003
  14. Beach SR, Celano CM, Sugrue AM, Adams C, Ackerman MJ, Noseworthy PA, Huffman JC. QT prolongation, torsades de pointes, and psychotropic medications: a 5-year update. Psychosomatics 2018;59:105-122. https://doi.org/10.1016/j.psym.2017.10.009
  15. Lin CH, Chen MC, Wang SY, Lin CY. Predictive factors for QTc prolongation in schizophrenic patients taking antipsychotics. J Formos Med Assoc 2004;103:437-441.
  16. Cahoon WDJ. Acquired QT prolongation. Prog Cardiovasc Nurs 2009;24:30-33. https://doi.org/10.1111/j.1751-7117.2009.00021.x
  17. Algra A, Tijssen JG, Roelandt JR, Pool J, Lubsen J. QT interval variables from 24 hour electrocardiography and the two year risk of sudden death. Br Heart J 1993;70:43-48. https://doi.org/10.1136/hrt.70.1.43