CAJ | 학술논문

目的分析抗抑郁药诱发低钠血症的风险及相关危险因素。方法收集2009年1月至2010年12月在首都医科大学附属北京安定医院住院期间使用抗抑郁药患者的病历资料进行回顾性对照研究。低钠血症诊断标准为血清钠浓度＜135 mmol／L（轻、中、重度分别为131~＜135、120~130、＜120 mmol／L）。将住院期间至少1次检测显示血清钠浓度＜135 mmol／L的患者纳入低钠血症组，将第一次出现血钠浓度降低的检测日期定义为标定日期；血清钠浓度在135~144 mmol／L的患者纳入对照组，从低钠血症组患者标定日期±5 d范围内随机选取2或3例患者。比较2组患者的人口学特征、所患精神疾病、合并躯体疾病、标定日其他相关实验室检查指标、所用抗抑郁药种类及合并用药情况，应用多元Logistic回归方法对出现低钠血症的危险因素进行评估，结果以比值比（ OR）及其95％置信区间（ CI）表示。结果共214例患者纳入研究，低钠血症组58例，对照组156例。低钠血症组58例患者中出现轻、中和重度低钠血症者分别为38例（65.5％）、8例（13.8％）和12例（20.7％）。低钠血症组患者中年龄≥65岁、酒药依赖、使用选择性5-羟色胺再摄取抑制剂（ SSRI）者占比均明显高于对照组[65.5％（38／58）比37.8％（59／156），24.1％（14／58）比3.6％（6／156），69.0％（40／58）比38.5％（60／156），均P＜0.001]；合并肺部疾病以及联用抗癫痫药、利尿药或β受体阻滞剂者占比也明显高于对照组。多元Logistic回归分析显示，应用SSRI、年龄≥65岁、酒药依赖、联用抗癫痫药、利尿剂或β受体阻滞剂是患者出现低钠血症的危险因素[应用SSRI：χ2=8.336，OR=3.023，95％CI为1.02~9.67，P=0.001；年龄≥65岁：χ2=6.482，OR =2.911，95％CI 为1.36~9.06，P=0.032；酒药依赖：χ2=5.632，OR=2.428，95％CI为1.20~4.94，P=0.021；联用抗癫痫药：χ2=6.717，OR=2.217，95％CI为1.21~4.03，P=0.010；联用利尿药：χ2=5.893，OR=1.920，95％CI为1.07~3.44，P=0.028；联用β受体阻滞剂：χ2=3.853，OR=1.643，95％CI 为1.00~2.69，P=0.049]。结论抗抑郁药特别是SSRI存在诱发低钠血症的较高风险，年龄≥65岁、酒药依赖以及联用抗癫痫药、利尿剂或β受体阻滞剂是应用抗抑郁药患者发生低钠血症的危险因素。目的分析抗抑鬱藥誘髮低鈉血癥的風險及相關危險因素。方法收集2009年1月至2010年12月在首都醫科大學附屬北京安定醫院住院期間使用抗抑鬱藥患者的病歷資料進行迴顧性對照研究。低鈉血癥診斷標準為血清鈉濃度＜135 mmol／L（輕、中、重度分彆為131~＜135、120~130、＜120 mmol／L）。將住院期間至少1次檢測顯示血清鈉濃度＜135 mmol／L的患者納入低鈉血癥組，將第一次齣現血鈉濃度降低的檢測日期定義為標定日期；血清鈉濃度在135~144 mmol／L的患者納入對照組，從低鈉血癥組患者標定日期±5 d範圍內隨機選取2或3例患者。比較2組患者的人口學特徵、所患精神疾病、閤併軀體疾病、標定日其他相關實驗室檢查指標、所用抗抑鬱藥種類及閤併用藥情況，應用多元Logistic迴歸方法對齣現低鈉血癥的危險因素進行評估，結果以比值比（ OR）及其95％置信區間（ CI）錶示。結果共214例患者納入研究，低鈉血癥組58例，對照組156例。低鈉血癥組58例患者中齣現輕、中和重度低鈉血癥者分彆為38例（65.5％）、8例（13.8％）和12例（20.7％）。低鈉血癥組患者中年齡≥65歲、酒藥依賴、使用選擇性5-羥色胺再攝取抑製劑（ SSRI）者佔比均明顯高于對照組[65.5％（38／58）比37.8％（59／156），24.1％（14／58）比3.6％（6／156），69.0％（40／58）比38.5％（60／156），均P＜0.001]；閤併肺部疾病以及聯用抗癲癇藥、利尿藥或β受體阻滯劑者佔比也明顯高于對照組。多元Logistic迴歸分析顯示，應用SSRI、年齡≥65歲、酒藥依賴、聯用抗癲癇藥、利尿劑或β受體阻滯劑是患者齣現低鈉血癥的危險因素[應用SSRI：χ2=8.336，OR=3.023，95％CI為1.02~9.67，P=0.001；年齡≥65歲：χ2=6.482，OR =2.911，95％CI 為1.36~9.06，P=0.032；酒藥依賴：χ2=5.632，OR=2.428，95％CI為1.20~4.94，P=0.021；聯用抗癲癇藥：χ2=6.717，OR=2.217，95％CI為1.21~4.03，P=0.010；聯用利尿藥：χ2=5.893，OR=1.920，95％CI為1.07~3.44，P=0.028；聯用β受體阻滯劑：χ2=3.853，OR=1.643，95％CI 為1.00~2.69，P=0.049]。結論抗抑鬱藥特彆是SSRI存在誘髮低鈉血癥的較高風險，年齡≥65歲、酒藥依賴以及聯用抗癲癇藥、利尿劑或β受體阻滯劑是應用抗抑鬱藥患者髮生低鈉血癥的危險因素。
목적분석항억욱약유발저납혈증적풍험급상관위험인소。방법수집2009년1월지2010년12월재수도의과대학부속북경안정의원주원기간사용항억욱약환자적병력자료진행회고성대조연구。저납혈증진단표준위혈청납농도＜135 mmol／L（경、중、중도분별위131~＜135、120~130、＜120 mmol／L）。장주원기간지소1차검측현시혈청납농도＜135 mmol／L적환자납입저납혈증조，장제일차출현혈납농도강저적검측일기정의위표정일기；혈청납농도재135~144 mmol／L적환자납입대조조，종저납혈증조환자표정일기±5 d범위내수궤선취2혹3례환자。비교2조환자적인구학특정、소환정신질병、합병구체질병、표정일기타상관실험실검사지표、소용항억욱약충류급합병용약정황，응용다원Logistic회귀방법대출현저납혈증적위험인소진행평고，결과이비치비（ OR）급기95％치신구간（ CI）표시。결과공214례환자납입연구，저납혈증조58례，대조조156례。저납혈증조58례환자중출현경、중화중도저납혈증자분별위38례（65.5％）、8례（13.8％）화12례（20.7％）。저납혈증조환자중년령≥65세、주약의뢰、사용선택성5-간색알재섭취억제제（ SSRI）자점비균명현고우대조조[65.5％（38／58）비37.8％（59／156），24.1％（14／58）비3.6％（6／156），69.0％（40／58）비38.5％（60／156），균P＜0.001]；합병폐부질병이급련용항전간약、이뇨약혹β수체조체제자점비야명현고우대조조。다원Logistic회귀분석현시，응용SSRI、년령≥65세、주약의뢰、련용항전간약、이뇨제혹β수체조체제시환자출현저납혈증적위험인소[응용SSRI：χ2=8.336，OR=3.023，95％CI위1.02~9.67，P=0.001；년령≥65세：χ2=6.482，OR =2.911，95％CI 위1.36~9.06，P=0.032；주약의뢰：χ2=5.632，OR=2.428，95％CI위1.20~4.94，P=0.021；련용항전간약：χ2=6.717，OR=2.217，95％CI위1.21~4.03，P=0.010；련용이뇨약：χ2=5.893，OR=1.920，95％CI위1.07~3.44，P=0.028；련용β수체조체제：χ2=3.853，OR=1.643，95％CI 위1.00~2.69，P=0.049]。결론항억욱약특별시SSRI존재유발저납혈증적교고풍험，년령≥65세、주약의뢰이급련용항전간약、이뇨제혹β수체조체제시응용항억욱약환자발생저납혈증적위험인소。
Objective To analyze the risk of hyponatremia induced by antidepressant drugs and related risk factors. Methods Medical record data of patients who were treated with antidepressant drugs during hospitalization in Beijing Anding Hospital,Capital Medical University from January 2009 to December 2010 were collected and a retrospective controlled study was conducted. The blood sodium level <135 mmol/L was defined as hyponatremia(the levels of 131-<135,120-130,and <120 mmol/L were defined as mild,moderate and severe hyponatremia,respectively). The patients whose serum sodium levels were <135 mmol/L at lease one time during hospitalization were enrolled into the hyponatremia group. The detection day when the serum sodium level was <135 mmol/L for the first time was defined as calibration date. The patients whose serum sodium levels were from 135 to 144 mmol/L were enrolled into the control group. They were selected randomly before or after 5 days of calibration date. The demographic characteristics, psychiatric diseases, combined somatic diseases, related laboratory examinations, antidepressant drugs,and other concomitant drugs in patients in the 2 groups were compared. The risk factors related to hyponatremia were evaluated using Logistic regression analysis and the odds ratios( OR) with 95% confidence intervals(95% CI)were calculated. Results A total of 214 patients were enrolled into the study. Of them,58 patients were in the hyponatremia group and 156 were in the control group. The numbers of patients with mild,moderate,and severe hyponatremia were 38(65. 5%),8(13. 8%),and 12(20. 7%),respectively,among the 56 patients in the hyponatremia group. The percentages of patients≥65 years old,with alcohol or drug dependence,selective serotonin reuptake inhibitors( SSRI)treatment in the hyponatremia group were higher than those in the control group[65. 5%(38/58)vs. 37. 8%(59/156),24. 1%(14/58)vs. 3. 6%(6/156),69. 0%(40/58)vs. 38. 5%(60/156),all P<0. 001]. The percentages of patients with lung disease,combined use of diuretics,anti-epileptics or β-adrenoceptor blockers in the hyponatremia patients were higher than those in the control group. The results of the Logistic regression analysis showed that SSRI treatment,age≥65 years,alcohol or drug dependence,combined use of diuretics,anti-epileptics or β-adrenoceptor blockers were risk factors related to hyponatremia[ SSRI treatment:χ2 =8. 336,OR=3. 023,95%CI:1. 02-9. 67,P=0. 001;age ≥65 years:χ2 =6. 482,OR=2. 911,95%CI:1. 36-9. 06,P=0. 032;alcohol or drug dependence:χ2 =5. 632,OR=2. 428,95%CI:1. 20-4. 94,P=0. 021;combined use of anti-epileptics:χ2 =6. 717,OR=2. 217,95%CI:1. 21-4. 03,P=0. 010;combined use of diuretics:χ2 =5. 893,OR=1. 920,95%CI:1. 07-3. 44,P=0. 028;combined use of β-adrenoceptor blockers:χ2 =3. 853,OR=1. 643,95%CI:1. 00-2. 69,P=0. 049]. Conclusions Antidepressive agents treatment,especially SSRI is a high-risk factor of hyponatremia. Age ≥ 65 years, alcohol or drug dependence,combined use of diuretics,anti-epileptics or β-adrenoceptor blockers are risk factors of hyponatremia in patients taking antidepressive agents.