与氯氮平相关的心肌炎和心肌病。
Myocarditis and cardiomyopathy associated with clozapine.
作者信息
Kilian J G, Kerr K, Lawrence C, Celermajer D S
机构信息
Department of Cardiology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia.
出版信息
Lancet. 1999 Nov 27;354(9193):1841-5. doi: 10.1016/s0140-6736(99)10385-4.
BACKGROUND
Clozapine is effective for resistant schizophrenia. After two sudden deaths in physically well young men soon after starting clozapine, we investigated the cardiovascular complications for this drug.
METHODS
From January, 1993, to March, 1999, 8000 patients started clozapine treatment in Australia, and were registered with a mandatory monitoring service. We identified cases of myocarditis and cardiomyopathy from voluntary reports to the Australian Adverse Drug Reaction Committee and sought details of the relevant diagnostic studies, necropsies that had been done in suspicious cases, or both.
FINDINGS
23 cases (20 men, three women, mean age 36 years [SD 9]) were identified: 15 of myocarditis and eight of cardiomyopathy associated with clozapine treatment. Six patients died. All cases of myocarditis (five deaths) occurred within 3 weeks of starting clozapine. Cardiomyopathy (one death) was diagnosed up to 36 months after clozapine was started. Necropsy results showed mainly eosinophilic infiltrates with myocytolysis, consistent with an acute drug reaction.
INTERPRETATION
Clozapine therapy may be associated with potentially fatal myocarditis and cardiomyopathy in physically healthy young adults with schizophrenia.
背景
氯氮平对难治性精神分裂症有效。在两名身体健康的年轻男性开始服用氯氮平后不久突然死亡后，我们对该药物的心血管并发症进行了调查。
方法
从1993年1月至1999年3月，8000名患者在澳大利亚开始接受氯氮平治疗，并在一项强制性监测服务中进行了登记。我们从向澳大利亚药物不良反应委员会的自愿报告中确定了心肌炎和心肌病病例，并寻求相关诊断研究的详细信息、可疑病例中进行的尸检细节或两者皆有。
结果
确定了23例（20名男性，3名女性，平均年龄36岁[标准差9]）：15例为与氯氮平治疗相关的心肌炎，8例为心肌病。6名患者死亡。所有心肌炎病例（5例死亡）均在开始服用氯氮平后3周内发生。心肌病（1例死亡）在开始服用氯氮平后36个月内被诊断出来。尸检结果主要显示嗜酸性粒细胞浸润伴肌细胞溶解，符合急性药物反应。
解读
氯氮平治疗可能与患有精神分裂症的身体健康的年轻成年人中潜在致命的心肌炎和心肌病有关。
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