Dursun Recep, Alpaslan Mete, Caliskan Mustafa, Ciftci Ozgur, Kulaksizoglu Sevsen, Seckin Deniz, Muderrisoglu Haldun
Baskent University, Faculty of Medicine, Department of Dermatology, Konya Research Center, Konya, Turkey.
J Drugs Dermatol. 2011 Jul;10(7):710-4.
Isotretinoin is a widely prescribed drug for the treatment of severe acne. Several adverse cardiac effects due to isotretinoin have been previously reported. However, no data exist on the effects of isotretinoin therapy on QT intervals.
To investigate the effects of isotretinoin therapy on QT intervals and QT dispersion, and also to see if it is related to serum lipids, homocysteine and lipoprotein (a) or not.
Forty-five patients with severe acne (mean age 21±6 years, range 14-38 years; 26 female) were included in the study. Twelve-lead surface electrocardiograms (ECGs) were acquired at three stages: before therapy and at the ends of the first and sixth months of 0.8 mg/kg/day of isotretinoin therapy. Serum levels of triglycerides, total cholesterol, low density lipoprotein cholesterol, high density lipoprotein cholesterol, very low density lipoprotein cholesterol, homocysteine and lipoprotein (a) were also measured at the day of ECG recordings. Minimum and maximum QT intervals were measured and QT dispersion was calculated.
Mean heart rates were similar throughout the isotretinoin therapy. Serum levels of lipids, homocysteine and lipoprotein (a) all increased significantly at the end of the first month and remained significantly elevated at the end of sixth month (P is less than 0.05 for both stages). QT intervals and QT dispersion did not differ significantly throughout the six months of isotretinoin therapy (P is greater than 0.05).
In patients with severe acne, six months of 0.8 mg/kg/day of isotretinoin therapy neither prolongs QT interval, nor increases QT dispersion. This effect is not related to blood lipids, homocysteine or lipoprotein (a) levels. Our findings indicate that from the point of polymorphic ventricular tachycardia risk, 0.8 mg/kg/day of isotretinoin therapy is a safe choice in acne treatment.
异维A酸是一种广泛用于治疗重度痤疮的药物。此前已有多项关于异维A酸引起的不良心脏效应的报道。然而，尚无关于异维A酸治疗对QT间期影响的数据。
研究异维A酸治疗对QT间期和QT离散度的影响，并观察其是否与血脂、同型半胱氨酸及脂蛋白(a)有关。
45例重度痤疮患者（平均年龄21±6岁，范围14 - 38岁；26例女性）纳入本研究。在三个阶段采集12导联体表心电图(ECG)：治疗前、异维A酸0.8mg/kg/天治疗的第一个月末和第六个月末。在记录心电图当天还测量了甘油三酯、总胆固醇、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇、极低密度脂蛋白胆固醇、同型半胱氨酸和脂蛋白(a)的血清水平。测量QT间期的最小值和最大值并计算QT离散度。
在整个异维A酸治疗过程中平均心率相似。血脂、同型半胱氨酸和脂蛋白(a)的血清水平在第一个月末均显著升高，并在第六个月末仍显著升高（两个阶段P均小于0.05）。在异维A酸治疗的六个月中，QT间期和QT离散度无显著差异（P大于0.05）。
在重度痤疮患者中，0.8mg/kg/天的异维A酸治疗六个月既不延长QT间期，也不增加QT离散度。这种效应与血脂、同型半胱氨酸或脂蛋白(a)水平无关。我们的研究结果表明，从多形性室性心动过速风险的角度来看，0.8mg/kg/天的异维A酸治疗是痤疮治疗中的一个安全选择。
