Curto Martina, Girardi Nicoletta, Lionetto Luana, Ciavarella Giuseppino M, Ferracuti Stefano, Baldessarini Ross J
International Consortium for Psychotic and Mood Disorders, McLean Hospital, Belmont, MA, USA.
Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
Curr Psychiatry Rep. 2016 Jul;18(7):68. doi: 10.1007/s11920-016-0704-3.
Clozapine is exceptionally effective in psychotic disorders and can reduce suicidal risk. Nevertheless, its use is limited due to potentially life-threatening adverse effects, including myocarditis and cardiomyopathy. Given their clinical importance, we systematically reviewed research on adverse cardiac effects of clozapine, aiming to improve estimates of their incidence, summarize features supporting their diagnosis, and evaluate proposed monitoring procedures. Incidence of early (≤2 months) myocarditis ranges from <0.1 to 1.0 % and later (3-12 months) cardiomyopathy about 10 times less. Diagnosis rests on relatively nonspecific symptoms, ECG changes, elevated indices of myocardial damage, cardiac MRI findings, and importantly, echocardiographic evidence of developing ventricular failure. Treatment involves stopping clozapine and empirical applications of steroids, diuretics, beta-blockers, and antiangiotensin agents. Mortality averages approximately 25 %. Safety of clozapine reuse remains uncertain. Systematic studies are needed to improve knowledge of the epidemiology, avoidance, early identification, and treatment of these adverse effects, with effective and practicable monitoring protocols.
氯氮平对精神障碍异常有效，且可降低自杀风险。然而，由于其存在包括心肌炎和心肌病在内的潜在危及生命的不良反应，其应用受到限制。鉴于这些不良反应的临床重要性，我们系统回顾了关于氯氮平心脏不良反应的研究，旨在改进对其发生率的估计，总结支持其诊断的特征，并评估建议的监测程序。早期（≤2个月）心肌炎的发生率为<0.1%至1.0%，后期（3 - 12个月）心肌病的发生率约为前者的十分之一。诊断基于相对非特异性的症状、心电图变化、心肌损伤指标升高、心脏磁共振成像结果，重要的是，基于出现心室功能衰竭的超声心动图证据。治疗包括停用氯氮平以及经验性应用类固醇、利尿剂、β受体阻滞剂和抗血管紧张素药物。死亡率平均约为25%。氯氮平再次使用的安全性仍不确定。需要进行系统研究以增进对这些不良反应的流行病学、预防、早期识别和治疗的了解，并制定有效且可行的监测方案。
