抗精神病药可使老年痴呆患者死亡风险增加
Title:Antipsychotic Drug Use and Mortality in Older Adults with Dementia抗精神病药可使老年痴呆患者死亡风险增加
Author: Sudeep S. Gill, MD, MSc; Susan E. Bronskill, PhD; Sharon-Lise T. Normand, PhD; et al
Resource: Annals of Internal Medicine, 5 June 2007 | Volume 146 Issue 11 | Pages 775-786
ABSTRACT 摘要
Background: Antipsychotic drugs are widely used to manage behavioral and psychological symptoms in dementia despite concerns about their safety.
背景：尽管关于抗精神病药的安全性存在争议，但其仍广泛应用于行为性以及心理上的痴呆症状者。
Objective: To examine the association between treatment with antipsychotics (both conventional and atypical) and all-cause mortality.
目的：对应用抗精神病药物与各种原因致死亡之间的相关性进行研究。
Design: Population-based, retrospective cohort study.
研究设计：基于人群的回顾性队列研究
Setting: Ontario, Canada.
研究地点：安大略省，加拿大
Patients: Older adults with dementia who were followed between 1 April 1997 and 31 March 2003.
研究对象：选取从1997年4月1日至2003年3月31日之间的老年痴呆患者。
Measurements: The risk for death was determined at 30, 60, 120, and 180 days after the initial dispensing of antipsychotic medication. Two pairwise comparisons were made: atypical versus no antipsychotic use and conventional versus atypical antipsychotic use. Groups were stratified by place of residence (community or long-term care). Propensity score matching was used to adjust for differences in baseline health status.
评估方法：对抗精神病药物的初期治疗后30日，60日，120日以及180日确定其导致的死亡风险。通过两个配对比较研究：非标准的运用抗精神病药物治疗对比未应用抗精神病药物治疗，以及传统应用抗精神病药物治疗对比非标准的应用抗精神病药物治疗。组别分配依据居住场所（社区或长期护理）。运用匹配倾向评分校正对于初始健康状态的差异。
Results: A total of 27 259 matched pairs were identified. New use of atypical antipsychotics was associated with a statistically significant increase in the risk for death at 30 days compared with nonuse in both the community-dwelling cohort (adjusted hazard ratio, 1.31 [95% CI, 1.02 to 1.70]; absolute risk difference, 0.2 percentage point) and the long-term care cohort (adjusted hazard ratio, 1.55 [CI, 1.15 to 2.07]; absolute risk difference, 1.2 percentage points). Excess risk seemed to persist to 180 days, but unequal rates of censoring over time may have affected these results. Relative to atypical antipsychotic use, conventional antipsychotic use was associated with a higher risk for death at all time points. Sensitivity analysis revealed that unmeasured confounders that increase the risk for death could diminish or eliminate the observed associations.
结果：总计对27259配对进行研究。非标准抗精神病药物的新用法与未运用抗精神病药物中用药30日后的死亡风险性统计学上的显著增加相关，其中在社区居住队列组别（校正危害比为1.31，95%可信区间为1.02至1.70，绝对风险差异为0.2百分点）中和在长期护理组（校正危害比为1.55，95%可信区间为1.15至2.07，绝对风险差异为1.2百分点）中都如此。过多的风险似乎持续到180天，但随时间增长的不对应性可能影响了这些结果。相对于非标准运用抗精神病药物而言，传统的抗精神病药物运用在各个时间点上均与死亡高风险性相关。灵敏性分析表明存在死亡风险性增加会减少或去除观察相关性的混杂（因素）。
Limitations: Information on causes of death was not available. Many patients did not continue their initial treatments after 1 month of therapy. Unmeasured confounders could affect associations.
研究局限性：研究中未获得死亡原因。许多患者在治疗1月后不能持续他们的初期治疗。无法预测的混杂因素可影响相关性。
Conclusions: Atypical antipsychotic use is associated with an increased risk for death compared with nonuse among older adults with dementia. The risk for death may be greater with conventional antipsychotics than with atypical antipsychotics.
结论：在老年痴呆患者中，非标准地运用抗精神病药物患者对比不运用抗精神病药物患者而言与死亡风险性增加相关。运用传统的抗精神病药物的患者较非标准运用抗精神病药物具有更高的死亡风险。
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