选择性 5-羟色胺再摄取抑制剂与尖端扭转型室性心动过速：系统评价病例报告得出的新概念和新方向。
Selective serotonin reuptake inhibitors and torsade de pointes: new concepts and new directions derived from a systematic review of case reports.
机构信息
Department of Psychiatry, Virginia Commonwealth University, Richmond, VA, USA.
Department of Pharmacy, Virginia Commonwealth University, Richmond, VA, USA.
出版信息
Ther Adv Drug Saf. 2013 Oct;4(5):189-98. doi: 10.1177/2042098613492366.
OBJECTIVE
In the light of the recent United States Food and Drug Administration (FDA) warning to clinicians on using previously approved doses of citalopram because of the purported higher risk of torsade de pointes (TdP), we pursued the broader question: are selective serotonin reuptake inhibitor (SSRI) antidepressant agents as a group unsafe because they might induce QTc interval prolongation and TdP?
METHOD
We reviewed the literature and found only 15 case reports (6 of fluoxetine, 1 of sertraline and 8 of citalopram) of SSRI-associated QTc interval prolongation linking to TdP.
RESULTS
A total of 13 cases contained sufficient information for analysis. In the setting of TdP, QTc interval prolongation does not clearly relate to SSRI dose.
CONCLUSION
Applying conventional statistics as the FDA does may not be the best tool to study this phenomenon because SSRI-associated TdP is a very rare event and hence best understood as an 'extreme outlier'. Despite the limitations inherent in case report material, case reports on drug-associated QTc interval prolongation and TdP provide valuable information that should be considered along with other sources of information for clinical guidance.
目的
鉴于美国食品和药物管理局（FDA）最近警告临床医生，由于据称更高的尖端扭转型室性心动过速（TdP）风险，应避免使用先前批准的西酞普兰剂量，我们提出了更广泛的问题：作为一个群体，选择性 5-羟色胺再摄取抑制剂（SSRI）抗抑郁药是否不安全，因为它们可能会导致 QTc 间期延长和 TdP？
方法
我们回顾了文献，仅发现了 15 例与 SSRI 相关的 QTc 间期延长与 TdP 相关的病例报告（氟西汀 6 例，舍曲林 1 例，西酞普兰 8 例）。
结果
共有 13 例包含足够的信息进行分析。在 TdP 的情况下，QTc 间期延长与 SSRI 剂量之间没有明显的关系。
结论
FDA 采用的常规统计学方法可能不是研究这种现象的最佳工具，因为 SSRI 相关的 TdP 是一种非常罕见的事件，因此最好被理解为“极端异常值”。尽管病例报告材料存在固有局限性，但与药物相关的 QTc 间期延长和 TdP 的病例报告提供了有价值的信息，应与其他信息来源一起考虑，以提供临床指导。
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