抗精神病药物诱导心房纤颤的研究进展

Research Advances in Antipsychotic Drug-Induced Atrial Fibrillation

摘要: 抗精神病药物在治疗精神分裂症、双相情感障碍等精神疾病中具有重要地位，但其心血管不良反应，特别是诱发心房纤颤(房颤)的风险，正日益受到关注。本文对于抗精神病药物与心房纤颤的关系、风险性和相关影响因素进行综述，并且进一步论述了其潜在的作用机制。以“Antipsychotic drug、atrial fibrillation”为检索词在Web of Science、PubMed、SCI-hub数据库中检索1974年1月到2024年6月的文献。回顾了既往发生的病例报告。例如，自1978年起陆续有氯氮平、奥氮平等药物引发房颤的个案报道，部分患者在停药后房颤症状缓解，重新用药后复发。既往的流行病学研究提示抗精神病药物使用与房颤风险显著相关，风险程度与药物类型、剂量、用药时长及患者自身心血管状况有关。其作用机制，目前尚未完全明确，但研究提出了几种可能途径：包括药物引起的自主神经功能紊乱、毒蕈碱受体阻断、心房传导异常，以及代谢紊乱(如体重增加、血糖和血脂异常)等。近期研究还提出AMP激活的蛋白激酶(AMPK)可能在其中发挥关键作用。因此，在临床使用抗精神病药物时，建议密切监测患者心电图变化，特别是对具有心血管风险因素的患者，应从低剂量开始治疗，必要时调整用药方案，以降低房颤及其他心血管事件的风险。

Abstract: Antipsychotics play an important role in the treatment of schizophrenia, bipolar disorder and other mental diseases, but their adverse cardiovascular reactions, especially the risk of atrial fibrillation, are attracting increasing attention. This article reviews the relationship, risks and related influencing factors between antipsychotics and atrial fibrillation, and further discusses its potential mechanism. Taking “Antipsychotic drug, atypical fibrosis” as the search term, this paper makes a search on Web of Science, PubMed, SCI-hub. The literature from January 2004 to June 2024 was searched in the database. The previous case reports were reviewed. For example, since 1978, there have been cases of atrial fibrillation caused by clozapine, olanzapine and other drugs. Some patients have relieved their symptoms of atrial fibrillation after stopping taking drugs and relapsed after taking drugs again. Previous epidemiological studies suggest that the use of antipsychotics is significantly related to the risk of atrial fibrillation, and the degree of risk is related to the type, dosage, duration of medication and the patient’s own cardiovascular status. At present, its mechanism of action is not completely clear, but several possible ways have been put forward, including drug-induced autonomic nervous dysfunction, muscarinic receptor blockade, abnormal atrial conduction, and metabolic disorders (such as weight gain, abnormal blood sugar and blood lipid). Recent studies also suggest that AMP-activated protein kinase (AMPK) may play a key role in it. Therefore, when using antipsychotic drugs in clinic, it is suggested to closely monitor the changes of patients’ electrocardiogram, especially for patients with cardiovascular risk factors, and start treatment with low dose, and adjust the medication regimen when necessary to reduce the risk of atrial fibrillation and other cardiovascular events.