Leong Bin Abdullah Mohammad Farris Iman, Singh Darshan
Lifestyle Science Cluster, Advanced Medical and Dental Institute, Universiti Sains Malaysia, Kepala Batas, Malaysia.
Centre for Drug Research, Universiti Sains Malaysia, Gelugor, Malaysia.
Front Pharmacol. 2021 Sep 27;12:726003. doi: 10.3389/fphar.2021.726003. eCollection 2021.
Kratom or (Korth.) has received overwhelming attention recently due to its alleged pain-relieving effects. Despite its potential therapeutic value, kratom use has been linked to many occurrences of multiorgan toxicity and cardiotoxicity. Accordingly, the current narrative review aimed to provide a detailed account of kratom's adverse cardiovascular effects and cardiotoxicity risk, based on studies, poison center reports, coroner and autopsy reports, clinical case reports, and clinical studies. An electronic search was conducted to identify all research articles published in English from 1950 to 2021 using the major research databases, such as Google Scholar, Web of Science, PubMed, Scopus, Mendeley, EMBASE, Cochrane Library, and Medline. We then analyzed the literature's discussion of adverse cardiovascular effects, toxicity, and mortality related to kratom use. Our findings revealed that, although studies have found kratom preparations' most abundant alkaloid--to cause a prolonged QTc interval and an increased risk of torsades de pointes, a clinical study examining humans' regular consumption of kratom did not report such a risk. However, this latter study did show that regular kratom use could induce an increased QTc interval in a dose-dependent manner. A few case reports also highlighted that kratom consumption is associated with ventricular arrhythmia and cardiopulmonary arrest, but this association could have ensued when kratom was co-administered with another substance. Similarly, analyses of national poison data showed that kratom's most common adverse acute cardiovascular effects include tachycardia and hypertension. Meanwhile, coroner and autopsy reports indicated that kratom's cardiovascular sequelae encompass coronary atherosclerosis, myocardial infarction, hypertensive cardiovascular disease, left ventricular hypertrophy, cardiac arrhythmia, cardiomegaly, cardiomyopathy, focal band necrosis in the myocardium, and myocarditis. Given the available data, we deduced that all cardiac eventualities reported in the literature could have been compounded by polysubstance use and unresolved underlying medical illnesses. Although kratom use has been associated with death and cardiotoxicity, especially at higher doses and when associated with other psychoactive drugs, the dearth of data and methodological limitations reported in existing studies do not allow a definitive conclusion, and further studies are still necessary to address this issue.
kratom（学名：Mitragyna speciosa (Korth.)）最近因其所谓的止痛效果而受到了极大关注。尽管它具有潜在的治疗价值，但 kratom 的使用已与多起多器官毒性和心脏毒性事件相关联。因此，本次叙述性综述旨在基于研究、中毒控制中心报告、验尸官和尸检报告、临床病例报告以及临床研究，详细阐述 kratom 的不良心血管影响和心脏毒性风险。通过电子检索，利用谷歌学术、科学网、PubMed、Scopus、Mendeley、EMBASE、Cochrane 图书馆和 Medline 等主要研究数据库，查找 1950 年至 2021 年期间发表的所有英文研究文章。然后，我们分析了文献中关于 kratom 使用相关的不良心血管影响、毒性和死亡率的讨论。我们的研究结果显示，尽管研究发现 kratom 制剂中最丰富的生物碱——会导致 QTc 间期延长和尖端扭转型室性心动过速风险增加，但一项关于人类定期服用 kratom 的临床研究并未报告此类风险。然而，后一项研究确实表明，定期使用 kratom 可呈剂量依赖性地诱导 QTc 间期延长。一些病例报告还强调，服用 kratom 与室性心律失常和心肺骤停有关，但这种关联可能是在 kratom 与另一种物质联合使用时出现的。同样，对国家中毒数据的分析表明，kratom 最常见的不良急性心血管影响包括心动过速和高血压。与此同时，验尸官和尸检报告表明，kratom 的心血管后遗症包括冠状动脉粥样硬化、心肌梗死、高血压性心血管疾病、左心室肥厚、心律失常、心脏肥大、心肌病、心肌局灶性带状坏死和心肌炎。鉴于现有数据，我们推断文献中报道的所有心脏情况可能因多物质使用和未解决的潜在疾病而更加复杂。尽管使用 kratom 与死亡和心脏毒性有关，尤其是在高剂量以及与其他精神活性药物联合使用时，但现有研究报告的数据匮乏和方法学局限性使得无法得出明确结论，仍需要进一步研究来解决这个问题。
