School of Medicine, Nantong University, Nantong, Jiangsu, PR China.
School of Public Health, Nantong University, Nantong, Jiangsu, PR China.
J Psychopharmacol. 2023 Oct;37(10):971-981. doi: 10.1177/02698811231190864. Epub 2023 Aug 3.
QTc prolongation is one of the possible complications in patients with schizophrenia taking antipsychotics, which leads to malignant cardiac arrhythmia. No meta-analysis has been reported assessing the prevalence and correlated risk factors for QTc prolongation.
This meta-analysis aimed to assess the evidence for the prevalence of QTc prolongation and correlated risk factors in patients with schizophrenia taking antipsychotics. Web of Science and PubMed were searched according to preset strategy. The quality of research was assessed by the Newcastle-Ottawa Scale (NOS).
In all, 15 studies covering 15,540 patients with schizophrenia taking antipsychotics were included. Meta-analysis showed that the prevalence of QTc prolongation in patients with schizophrenia taking antipsychotics was about 4.0% (95% confidence interval (CI): 3.0%-5.0%, < 0.001). The prevalence was about 4.0% in Asia (95%CI: 3.0%-6.0%, < 0.001), about 5.0% in Europe (95%CI: 2.0%-7.0%, < 0.001), and about 2.0% in America (95%CI: 1.0%-3.0%, < 0.001). Sensitivity analyses indicated the robustness of the result. Publication bias analysis reported a certain publication bias ( = 3.37, = 0.012). Meta-regression suggested that female and elderly patients were clinically associated with a higher prevalence of QTc prolongation. According to included studies, smoking, comorbidity of cardiovascular disease, and abnormal levels of high-density lipoprotein/low-density lipoprotein might be related to QTc prolongation in patients with schizophrenia taking antipsychotics.
The prevalence of QTc prolongation in patients with schizophrenia taking antipsychotics was about 4.0%. Female and elderly patients were more likely to experience QTc prolongation. Close electrocardiogram monitoring was suggested in these at-risk populations.
精神分裂症患者服用抗精神病药物后可能会出现 QTc 延长，从而导致恶性心律失常。目前尚无评估 QTc 延长发生率及相关危险因素的荟萃分析。
本荟萃分析旨在评估抗精神病药物治疗的精神分裂症患者 QTc 延长发生率及相关危险因素的证据。根据预设策略，检索 Web of Science 和 PubMed。采用纽卡斯尔-渥太华量表（NOS）评估研究质量。
共纳入 15 项研究，涵盖 15540 例抗精神病药物治疗的精神分裂症患者。荟萃分析显示，抗精神病药物治疗的精神分裂症患者 QTc 延长发生率约为 4.0%（95%可信区间：3.0%-5.0%， < 0.001）。亚洲地区发生率约为 4.0%（95%可信区间：3.0%-6.0%， < 0.001），欧洲地区发生率约为 5.0%（95%可信区间：2.0%-7.0%， < 0.001），美洲地区发生率约为 2.0%（95%可信区间：1.0%-3.0%， < 0.001）。敏感性分析表明结果稳健。发表偏倚分析显示存在一定的发表偏倚（ = 3.37， = 0.012）。Meta 回归提示女性和老年患者与 QTc 延长的发生率较高有关。根据纳入的研究，吸烟、合并心血管疾病以及高密度脂蛋白/低密度脂蛋白异常可能与抗精神病药物治疗的精神分裂症患者 QTc 延长有关。
抗精神病药物治疗的精神分裂症患者 QTc 延长发生率约为 4.0%。女性和老年患者更有可能发生 QTc 延长。建议这些高危人群密切进行心电图监测。
