Udruženost težine depresije, upotrebe paroksetina i markera oštećenja jetre sa dužinom QT intervala kod zavisnika od alkohola
Sažetak
Uvod/Cilj. Oboleli od hronične alkoholne bolesti vrlo često imaju depresiju i kardiomiopatiju. Lečenje sa nekim antidepresivima je povezano s produženim QT intervalom, ventrikularnim aritmijama i iznenadnom smrću. Cilj ove studije bio je da se utvrdi odnos između težine depresije, nivoa gama-glutamil transferaze (GGT) u serumu, kao markera oštećenja jetre, i mogućeg uticaja korišćenja paroksetina na trajanje QT intervala kod bolesnika kod kojih je započeto lečenje hronične alkoholne zavisnosti. Metode. U ispitivanje je bilo uključeno 147 osoba muškog pola, starijih od 18 godina, zavisnih od alkohola, kod kojih je na početku hospitalizacije na osnovu DSM-IV kriterijuma i pozitivne Hamiltonove skale za procenu depresije (HRSD) dijagnostikovan depresivni poremećaj. Od ukupnog broja ispitanika, njih 49 je metodom slučajnog izbora lečeno antidepresivom paroksetinom u dozi od 20 mg, jedanput dnevno, tokom 20 dana. Globalni QTc interval određivan je automatski. Rezultati. U uzorku od 147 depresivnih bolesnika sa alkoholnom zavisnošću, pre ordiniranja bilo kog antidepresivnog leka, primenom generalizovanog linearnog modela utvrđena je statistički značajna pozitivna korelacija između dužine QTc intervala i serumskih nivoa GGT, tj. intenziteta alkoholizma (p = 0.002), odnosno vrednosti HRSD skora, tj. intenziteta depresije (p = 0.021). I pored vulnerabilnosti bolesnika zbog oštećenja miokarda i poremaćaja funkcionisanja jetre izazvanog konzumiranjem alkohola i, posledično, izmenjenog metabolizma lekova, nije utvrđeno produženje QTc intervala usled primene paroksetina. Dvadeset dana posle primene paroksetina dužina QTc interval iznosila je 401.43 ms, a pre njegove primene 403.31 ms. Razlika u dužini QTc intervala (nakon i pre ordiniranja paroksetina) iznosila je ΔQTc = -1.88 ms (p = 0.524). Zaključak. Rezultati pokazuju da težina depresije i nivoi GGT u serumu pozitivno korelišu sa dužinom QT intervala. Sa druge strane, paroksetin nakon 20 dana primene, nije produžio QT interval.
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