| 张凯,程朝阳,王雨婷.氯胺酮在精神疾病治疗中的研究进展[J].四川精神卫生杂志,2025,(4):289-294.Zhang Kai,Cheng Zhaoyang,Wang Yuting,Advances in ketamine therapy for multiple psychiatric disorders[J].SICHUAN MENTAL HEALTH,2025,(4):289-294 |
| 氯胺酮在精神疾病治疗中的研究进展 |
| Advances in ketamine therapy for multiple psychiatric disorders |
| 投稿时间：2025-05-31 |
| DOI：10.11886/scjsws20250531003 |
| 中文关键词: 氯胺酮 艾司氯氨酮 快速抗抑郁 NMDA受体 精神疾病 |
| 英文关键词:Ketamine Esketamine Rapid antidepressant NMDA receptor Psychiatric disorders |
| 基金项目:安徽省教育厅高校自然科学研究重点项目（项目名称：R-氯胺酮经小胶质细胞TGF-β-ERK/MAPK信号通路快速抗抑郁机制研究；项目编号：2023AH050647）；安徽省教育厅2022年高校优秀青年人才支持计划项目（项目编号：gxyqZD2022022） |
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| 中文摘要: |
| 氯胺酮是一种非竞争性N-甲基-D-天冬氨酸（NMDA）受体拮抗剂，近年来因其在难治性抑郁症和自杀意念干预中的快速起效作用而备受关注。氯胺酮通过拮抗NMDA受体、激活AMPA通路，上调BDNF/mTOR信号等机制发挥作用。其对映异构体艾司氯氨酮和R-氯胺酮及代谢物在疗效和机制上存在差异。艾司氯胺酮鼻喷剂已在欧美和中国获批用于治疗难治性抑郁症，并被证明可快速改善抑郁症状和急性自杀意念。与之相比，R-氯胺酮则显示出更持久且更高的安全性。本文系统述评了氯胺酮及其对映异构体的药理机制、药代动力学特征及其在抑郁障碍、双相情感障碍、成瘾性疾病、创伤后应激障碍和强迫症治疗中的研究进展。尽管氯胺酮的疗效有着多方面的潜力，但其解离、认知损伤、滥用风险等安全性问题仍需关注。 |
| 英文摘要: |
| Ketamine， a non-competitive N-methyl-D-aspartate （NMDA） receptor antagonist， has gained increasing attention for its rapid antidepressant effects in treatment-resistant depression （TRD） and suicidal ideation. Its mechanisms include NMDA receptor blockade， AMPA receptor activation， and upregulation of BDNF/mTOR signaling. Its enantiomers， esketamine and R-ketamine， as well as its metabolites， exhibit differences in efficacy and mechanisms. Intranasal esketamine has been approved in the Europe， United States， and China for TRD， demonstrating rapid efficacy in alleviating depressive symptoms and acute suicidal ideation. In contrast， R-ketamine demonstrates potential for longer-lasting effects and a improved safety profile. This review summarizes recent advances in the pharmacology， pharmacokinetics， and clinical applications of ketamine and its enantiomers in depressive disorders， bipolar disorder， substance use disorders， post-traumatic stress disorder and obsessive-compulsive disorder. Despite ketamine's multifaceted therapeutic potential， safety concerns such as dissociation， cognitive impairment， and abuse liability warrant continued attention.［Funded by Key Project of Natural Science Research for Universities of Anhui Provincial Education Department （number， 2023AH050647）； Anhui Provincial Department of Education Outstanding Young Talent Support Program Project 2022 （number， gxyqZD2022022）］ |
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