Hunter 5-羟色胺毒性标准 (HSTC)[4]Dunkley EJ, Isbister GK, Sibbritt D, et al. The Hunter Serotonin Toxicity Criteria: simple and accurate diagnostic decision rules for serotonin toxicity. QJM. 2003;96:635-642.http://qjmed.oxfordjournals.org/content/96/9/635.fullhttp://www.ncbi.nlm.nih.gov/pubmed/12925718?tool=bestpractice.com
目前已有若干临床诊断标准用以诊断 5-羟色胺中毒。根据文献制定的 Sternbach 标准是第一推荐标准,[11]Sternbach H. The serotonin syndrome. Am J Psychiatry. 1991;148:705-713.http://www.ncbi.nlm.nih.gov/pubmed/2035713?tool=bestpractice.com不包含某些最重要的诊断特征(如阵挛),包含许多非特异性特征。这导致在没有足够证据的情况下,将许多药物与 5-羟色胺中毒联系在一起:尤其是一些抗精神病药物。[15]Isbister GK, Downes F, Whyte IM. Olanzapine and serotonin toxicity. Psychiatry Clin Neurosci. 2003;57:241-242.http://www.ncbi.nlm.nih.gov/pubmed/12667176?tool=bestpractice.com[19]Nisijima K, Yoshino T, Yui K, et al. Potent serotonin (5-HT2A) receptor antagonists completely prevent the development of hyperthermia in an animal model of the 5-HT syndrome. Brain Res. 2001;890:23-31.http://www.ncbi.nlm.nih.gov/pubmed/11164765?tool=bestpractice.com这些标准现在已不再使用。
最好的诊断标准是 Hunter 5-羟色胺毒性标准 (HSTC),其具有良好的灵敏度 (84%) 和特异性 (97%)。[4]Dunkley EJ, Isbister GK, Sibbritt D, et al. The Hunter Serotonin Toxicity Criteria: simple and accurate diagnostic decision rules for serotonin toxicity. QJM. 2003;96:635-642.http://qjmed.oxfordjournals.org/content/96/9/635.fullhttp://www.ncbi.nlm.nih.gov/pubmed/12925718?tool=bestpractice.com根据大量 5-羟色胺能药物过量案例研究制定的这些标准目前已用于许多其他治疗药物的研究。[5]Taylor JJ, Wilson JW, Estes LL. Linezolid and serotonergic drug interactions: a retrospective survey. Clin Infect Dis. 2006;43:180-187.http://cid.oxfordjournals.org/content/43/2/180.fullhttp://www.ncbi.nlm.nih.gov/pubmed/16779744?tool=bestpractice.com[16]Evans RW, Tepper SJ, Shapiro RE, et al. The FDA alert on serotonin syndrome with use of triptans combined with selective serotonin reuptake inhibitors or selective serotonin-norepinephrine reuptake inhibitors: American Headache Society position paper. Headache. 2010;50:1089-1099.http://onlinelibrary.wiley.com/doi/10.1111/j.1526-4610.2010.01691.x/fullhttp://www.ncbi.nlm.nih.gov/pubmed/20618823?tool=bestpractice.com这些标准基于良好的神经系统专科检查,包括评估语调、阵挛和反射。
存在 5-羟色胺能药物时,如果出现以下症状,说明可能存在 5-羟色胺中毒:
[Figure caption and citation for the preceding image starts]: Hunter 5-羟色胺毒性标准 (HSTC) 算法来自 Geoffrey Isbister 医生的收藏 [Citation ends].