Anchersen Katinka, Clausen Thomas, Gossop Michael, Hansteen Viggo, Waal Helge
University of Oslo, Institute of Psychiatry, Norwegian Centre for Addiction Research (SERAF), Kirkeveien, Oslo, Norway.
Addiction. 2009 Jun;104(6):993-9. doi: 10.1111/j.1360-0443.2009.02549.x. Epub 2009 Apr 9.
To determine the prevalence of corrected QT interval (QTc) prolongation among patients in opioid maintenance treatment (OMT) and to investigate mortality potentially attributable to QTc prolongation in the Norwegian OMT programme.
Two hundred OMT patients in Oslo were recruited to the QTc assessment study between October 2006 and August 2007. The Norwegian register of all patients receiving OMT in Norway (January 1997-December 2003) and the national death certificate register were used to assess mortality. Mortality records were examined for the 90 deaths that had occurred among 2382 patients with 6450 total years in OMT.
The QTc interval was assessed by electrocardiography (ECG). All ECGs were examined by the same cardiologist, who was blind to patient history and medication. Mortality was calculated by cross-matching the OMT register and the national death certificate register: deaths that were possibly attributable to QTc prolongation were divided by the number of patient-years in OMT.
In the QTc assessment sample (n = 200), 173 patients (86.5%) received methadone and 27 (13.5%) received buprenorphine. In the methadone group, 4.6% (n = 8) had a QTc above 500 milliseconds; 15% (n = 26) had a QTc interval above 470 milliseconds; and 28.9% (n = 50) had a QTc above 450 milliseconds. All patients receiving buprenorphine (n = 27) had QTc results <450 milliseconds. A positive dose-dependent association was identified between QTc length and dose of methadone, and all patients with a QTc above 500 milliseconds were taking methadone doses of 120 mg or more. OMT patient mortality, where QTc prolongation could not be excluded as the cause of death, was 0.06/100 patient-years. Only one death among 3850 OMT initiations occurred within the first month of treatment.
Of the methadone patients, 4.6% had QTc intervals above 500 milliseconds. The maximum mortality attributable to QTc prolongation was low: 0.06 per 100 patient-years.
确定接受阿片类药物维持治疗（OMT）的患者中校正QT间期（QTc）延长的患病率，并调查挪威OMT项目中可能归因于QTc延长的死亡率。
2006年10月至2007年8月期间，招募了奥斯陆的200名接受OMT的患者参与QTc评估研究。利用挪威所有接受OMT患者的登记册（1997年1月至2003年12月）和国家死亡证明登记册来评估死亡率。对2382名患者（总共接受OMT 6450年）中发生的90例死亡的死亡记录进行了检查。
通过心电图（ECG）评估QTc间期。所有心电图均由同一位心脏病专家检查，该专家对患者病史和用药情况不知情。通过将OMT登记册与国家死亡证明登记册交叉匹配来计算死亡率：可能归因于QTc延长的死亡数除以OMT中的患者人年数。
在QTc评估样本（n = 200）中，173名患者（86.5%）接受美沙酮治疗，27名患者（13.5%）接受丁丙诺啡治疗。在美沙酮组中，4.6%（n = 8）的患者QTc超过500毫秒；15%（n = 26）的患者QTc间期超过470毫秒；28.9%（n = 50）的患者QTc超过450毫秒。所有接受丁丙诺啡治疗的患者（n = 27）的QTc结果均<450毫秒。确定QTc长度与美沙酮剂量之间存在正剂量依赖性关联，所有QTc超过500毫秒的患者服用的美沙酮剂量为120毫克或更多。在无法排除QTc延长作为死亡原因的情况下，OMT患者的死亡率为0.06/100患者人年。在3850例OMT起始病例中，只有1例死亡发生在治疗的第一个月内。
在美沙酮治疗的患者中，4.6%的患者QTc间期超过500毫秒。归因于QTc延长的最高死亡率较低：每100患者人年0.06。
