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肺炎风险,抗精神病剂量和精神分裂症中的抗胆固醇负担
Jurjen J Luykx1,2,3,4,5, Christoph U Correll6,7,8, Peter Manu9,10,11
1Department of Psychiatry, Amsterdam University Medical Center, Amsterdam, the Netherlands.
JAMA psychiatry
|June 26, 2024
概括
抗精神病药物,特别是克洛沙平,奎蒂亚平和奥兰沙平,增加了精神分裂症患者肺炎的风险. 高抗胆固醇负担和剂量依赖性影响是关键因素,需要有针对性的预防策略.
科学领域:
- 精神病学和药理学 精神病学和药理学
- 传染病流行病学 传染病流行病学
- 药物监督 药物监督 药物监督
背景情况:
- 观察性研究表明抗精神病药物,特别是克洛札,与肺炎有关.
- 风险的确切程度,剂量反应关系以及与肺炎相关的特定药物仍然不清楚.
研究的目的:
- 在精神分裂症患者中量化与特定抗精神病药物相关的肺炎风险.
- 调查多疗法,剂量和受体结合特性在抗精神病相关肺炎中的作用.
主要方法:
- 一项全国性的芬兰队列研究 (1996-2017年) 包括61,889名精神分裂症患者.
- 使用调整后的Cox比例危险回归模型分析了肺炎风险,将抗精神病药物的使用与不使用进行了比较.
- 暴露包括单疗法,多疗法,剂量 (低,中,高) 和抗胆固醇负担 (低,中,高).
主要成果:
- 总体而言,抗精神病药物的使用与肺炎没有显著的关联 (AHR,1.12;95% CI,0.99-1.26).
- 单疗法使用显示了肺炎风险的剂量依赖性增加 (AHR,1.15;P=.03).
- 具有高抗胆固醇负担的抗精神病药与增加的风险相关 (AHR,1.26;P<.001). 高剂量的奎平,高/中剂量的克洛沙平和高剂量的奥兰沙平与较高的肺炎风险特别相关.
结论:
- 抗精神病单一治疗和具有高抗胆固醇负担的药物增加了精神分裂症患者的肺炎风险,以剂量依赖的方式.
- 特定的药物,如克洛扎,奎蒂亚和奥兰扎在较高剂量时与肺炎风险增加有关.
- 预防策略应针对使用高风险抗精神病药物的精神分裂症患者.
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