Li Mier, Bai Yuncheng, Wang Yanjun, Xing Haoran, Zhang Yingying, Ding Wenjing, Ye Hong, Ma Li, Wang Weiwei, Bao Tianhao
Department of Science and Education, The Affiliated Mental Health Center of Kunming Medical University, Yunnan Mental Hospital, Kunming, Yunnan Province, 650032, People's Republic of China.
Department of Orthopedic Surgery, The First People's Hospital of Yunnan Province, Affiliated Hospital of Kunming University of Science and Technology, Kunming, Yunnan Province, 650032, People's Republic of China.
Neuropsychiatr Dis Treat. 2025 Mar 7;21:525-538. doi: 10.2147/NDT.S502312. eCollection 2025.
Currently, the treatment of schizophrenia remains primarily pharmacological, with approximately 30% of patients diagnosed with treatment-resistant schizophrenia (TRS). Clozapine continues to be the first choice treatment for this subgroup of patients. As the preferred treatment, clozapine offers clear advantages in efficacy; however, its complex and troublesome adverse effects pose significant challenges for psychiatrists. Common side effects include granulocytopenia, intestinal obstruction, myocarditis, cardiomyopathy, constipation, and seizures. The first two complications are easier to manage due to the availability of laboratory monitoring, and improved management strategies are now in place in clinical practice. In recent years, clozapine-induced myocarditis (CIM) has gained considerable attention because of its potentially severe outcomes. However, the mechanism behind its lethality remains unclear, and there is no widely accepted consensus or treatment guideline, which complicates the implementation of targeted prevention in clinical practice. This review aims to summarize the clinical manifestations of CIM, explore the underlying mechanisms, and discuss recent advances in monitoring, diagnosis, and treatment, with the goal of offering constructive recommendations for future clinical management.
目前，精神分裂症的治疗仍主要以药物治疗为主，约30%的精神分裂症患者被诊断为难治性精神分裂症（TRS）。氯氮平仍然是这一亚组患者的首选治疗药物。作为首选治疗药物，氯氮平在疗效方面具有明显优势；然而，其复杂且棘手的不良反应给精神科医生带来了重大挑战。常见的副作用包括粒细胞减少、肠梗阻、心肌炎、心肌病、便秘和癫痫发作。由于有实验室监测手段，前两种并发症较易处理，并且目前临床实践中已有改进的管理策略。近年来，氯氮平所致心肌炎（CIM）因其潜在的严重后果而受到了相当大的关注。然而，其致死背后的机制仍不清楚，并且没有广泛接受的共识或治疗指南，这使得临床实践中针对性预防措施的实施变得复杂。本综述旨在总结CIM的临床表现，探讨其潜在机制，并讨论监测、诊断和治疗方面的最新进展，以期为未来的临床管理提供建设性建议。
