血液羥氯奎寧濃度與QTc間期的相關性：台灣單一醫學中心的前導研究

Correlation of hydroxychloroquine blood levels and QTc interval in Taiwan: a pilot study in a tertiary medical center

目的：此研究旨在確定羥氯奎寧（hydroxychloroquine, HCQ）治療對免疫發炎疾病（immunemediated inflammatory disease）患者QTc間期的影響，並確定影響QTc延長的因素。
方法：此橫向分析包括了在國立台灣大學醫院診斷為免疫發炎疾病的55位患者。研究考慮了患者的特性、病史、用藥史和生活方式因素。血液中的羥氯奎寧濃度是使用液相色譜串聯質譜術測量的。QTc間期是使用Bazett公式計算的，並進行了統計分析以檢查羥氯奎寧使用、QTc間期持續時間以及影響因素之間的關係。
結果：雖然年齡較大，每單位體重羥氯奎寧劑量較高，以及慢性腎病（CKD）的存在與QTc間期延長的較高勝算比有相關趨勢，但只有年齡較大達到統計顯著性。線性迴歸模型顯示羥氯奎寧濃度與QTc間期之間存在正相關，但這一趨勢在統計上並不顯著。在由年齡和性別調整的多變量邏輯迴歸模型中，血液羥氯奎寧濃度和羥氯奎寧使用時間對QTc延長都沒有顯著影響。
結論：本研究發現血液羥氯奎寧濃度、羥氯奎寧使用時間和QTc間期延長之間無顯著相關性。對於年長患者，可能需要謹慎處方羥氯奎寧。我們的研究未發現HCQ使用與危及生命的QTc延長之間的關聯，需要進一步的調查。

Objective: This study aimed to determine the effects of hydroxychloroquine (HCQ) treatment on the QTc-interval in patients with immune-mediated disorders (IMIDs) and identify factors influencing QTc prolongation.
Methods: This cross-sectional analysis included 55 patients diagnosed with IMIDs at the National Taiwan University Hospital. The study considered patients’characteristics, medical history, medication history, and lifestyle factors. Blood HCQ concentration was measured using liquid chromatography tandem mass spectrometry. QTc interval was calculated using the Bazett formula, and statistical analyses were conducted to examine the relationships between HCQ use, QTc-interval duration, and influencing factors.
Results: While older age, higher HCQ dosage per weight, and the presence of chronic kidney disease (CKD) had trend with higher odds ratios for QTc prolongation. Only older age reached statistical significance. The linear regression model showed a positive correlation between HCQ concentration and QTc interval, but this trend was not statistically significant. Neither blood HCQ concentration nor duration of HCQ use showed a significant effect on QTc prolongation in a multivariate logistic regression model adjusted by age and gender.
Conclusions: No significant links were observed between blood HCQ levels, duration of use, and QTc prolongation. Caution was advised when prescribing HCQ for older patients. Our study did not find life-threatening QTc prolongation with HCQ use, warranting further investigation.