丹麦人口中的阿片类药物和痴呆症
Nelsan Pourhadi1, Janet Janbek1, Christiane Gasse2,3
1Danish Dementia Research Centre, Department of Neurology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark.
JAMA network open
|November 19, 2024
概括
长期使用阿片类药物超过90个总标准剂量 (TSD) 与痴呆症风险增加有关,特别是在90岁之前. 这种关联甚至适用于较弱的阿片类药物和慢性非癌症疼痛,因此需要进一步调查因果关系.
科学领域:
- 神经学 神经学
- 药理学 药理学是指药理学的学科.
- 流行病学 流行病学
背景情况:
- 片类药物的使用在疼痛管理中很常见,但其对认知健康的长期影响,特别是痴呆风险,仍然不完全理解.
- 现有的研究对长期,非癌症和弱阿片类药物使用和痴呆症有局限性.
- 澄清这些关联对于患者安全和临床指南至关重要.
研究的目的:
- 调查累积非癌症阿片类药物使用与患年龄相关全因痴呆症的风险之间的关联.
- 为了检查阿片类药物的不同累积暴露水平的痴呆风险.
- 评估这种关联是否不同于特定的患者群体,例如那些患有慢性非癌症疼痛或使用弱阿片类药物的患者.
主要方法:
- 使用丹麦国家登记册进行了嵌套病例控制研究,其中包括超过180万没有先前痴呆症或癌症的个人.
- 患有痴呆症的参与者与多达5个没有痴呆症的对照组相匹配.
- 累积阿片类药物暴露量化使用填写的处方从1995-2020年,使用条件逻辑回归进行统计分析.
主要成果:
- 低于90总标准剂量的阿片类药物使用与痴呆风险没有一致的关联.
- 超过90个TSD的暴露与90岁前痴呆症风险增加有关.
- 诊断时在各种年龄段观察到增加的风险,较高的TSD与更高的风险相关. 敏感性分析证实了慢性非癌症疼痛患者和弱阿片类药物使用者的关联.
结论:
- 超过90个TSD的累积阿片类药物使用与90岁之前痴呆的风险增加有关.
- 这种关联甚至在仅使用弱阿片类药物和患有慢性非癌症疼痛的人身上也很明显.
- 需要进一步的研究来确定这种观察到的关联是否代表阿片类药物使用和痴呆风险之间的因果关系.
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