小柯机器人

成功大学Edward Chia-Cheng Lai团队研究了抗精神病药物和胆碱酯酶抑制剂的使用与跌倒和骨折风险的相关性。这一研究成果发表在2021年9月9日出版的《英国医学杂志》上。

为了评估具有重大神经认知障碍的老年患者使用抗精神病药物和胆碱酯酶抑制剂与跌倒和骨折风险之间的关系，研究组进行了一项自我对照系列研究。在中国台北的全民健保资料库中招募了15278名成年人，年龄≥65岁，服用新开的抗精神病药物和胆碱酯酶抑制剂，在2006-2017年间发生过跌倒或骨折事件。

胆碱酯酶抑制剂的处方记录证实了重大神经认知障碍的诊断；所有胆碱酯酶抑制剂的使用均由专家审查。泊松回归分析用于得出不同治疗期间摔倒和骨折风险的发生率比率和95%置信区间：单独使用胆碱酯酶抑制剂，单独使用抗精神病药物，以及胆碱酯酶抑制剂和抗精神病药物联合使用，并与同一个体的非治疗期间进行比较。在开始研究药物之前，由于担心适应症的混淆，确定了14天的预处理期。

非治疗期每100人-年跌倒和骨折的发生率为8.30起，预处理期为52.35起，胆碱酯酶抑制剂和抗精神病药物联合使用时为10.55起，单独使用抗精神病药物为10.34其，单独使用胆碱酯酶抑制剂为9.41起。

与非治疗期相比，跌倒和骨折的最高风险发生在预处理期（校正后的发病率比率6.17），其次是胆碱酯酶抑制剂和抗精神病药物的联合治疗（1.35），以及单用抗精神病药物的治疗（1.33）和单用胆碱酯酶抑制剂（1.17）。

研究结果表明，治疗前跌倒和骨折的发生率较高，提示在评估跌倒和骨折风险与胆碱酯酶抑制剂和抗精神病药物使用之间的相关性时，应考虑研究药物以外的因素，如潜在疾病。

与非治疗期相比，治疗期也与更高的跌倒和骨折风险相关，尽管其程度远低于预处理期。在患者恢复更稳定的身体和精神状态之前，预防和密切监测跌倒风险的策略仍然很有必要。

附：英文原文

Title: Use of antipsychotic drugs and cholinesterase inhibitors and risk of falls and fractures: self-controlled case series

Author: Grace Hsin-Min Wang, Kenneth K C Man, Wei-Hung Chang, Tzu-Chi Liao, Edward Chia-Cheng Lai

Issue&Volume: 2021/09/09

Abstract:

Objective To evaluate the association between the use of antipsychotic drugs and cholinesterase inhibitors and the risk of falls and fractures in elderly patients with major neurocognitive disorders.

Design Self-controlled case series.

Participants 15278 adults, aged ≥65, with newly prescribed antipsychotic drugs and cholinesterase inhibitors, who had an incident fall or fracture between 2006 and 2017. Prescription records of cholinesterase inhibitors confirmed the diagnosis of major neurocognitive disorders; all use of cholinesterase inhibitors was reviewed by experts.

Main outcome measures Conditional Poisson regression was used to derive incidence rate ratios and 95% confidence intervals for evaluating the risk of falls and fractures for different treatment periods: use of cholinesterase inhibitors alone, antipsychotic drugs alone, and a combination of cholinesterase inhibitors and antipsychotic drugs, compared with the non-treatment period in the same individual. A 14 day pretreatment period was defined before starting the study drugs because of concerns about confounding by indication.

Results The incidence of falls and fractures per 100 person years was 8.30 (95% confidence interval 8.14 to 8.46) for the non-treatment period, 52.35 (48.46 to 56.47) for the pretreatment period, and 10.55 (9.98 to 11.14), 10.34 (9.80 to 10.89), and 9.41 (8.98 to 9.86) for use of a combination of cholinesterase inhibitors and antipsychotic drugs, antipsychotic drugs alone, and cholinesterase inhibitors alone, respectively. Compared with the non-treatment period, the highest risk of falls and fractures was during the pretreatment period (adjusted incidence rate ratio 6.17, 95% confidence interval 5.69 to 6.69), followed by treatment with the combination of cholinesterase inhibitors and antipsychotic drugs (1.35, 1.26 to 1.45), antipsychotic drugs alone (1.33, 1.24 to 1.43), and cholinesterase inhibitors alone (1.17, 1.10 to 1.24).

Conclusions The incidence of falls and fractures was high in the pretreatment period, suggesting that factors other than the study drugs, such as underlying diseases, should be taken into consideration when evaluating the association between the risk of falls and fractures and use of cholinesterase inhibitors and antipsychotic drugs. The treatment periods were also associated with a higher risk of falls and fractures compared with the non-treatment period, although the magnitude was much lower than during the pretreatment period. Strategies for prevention and close monitoring of the risk of falls are still necessary until patients regain a more stable physical and mental state.

DOI: 10.1136/bmj.n1925

Source: https://www.bmj.com/content/374/bmj.n1925

BMJ-British Medical Journal:《英国医学杂志》，创刊于1840年。隶属于BMJ出版集团，最新IF：93.333
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