法国波尔多大学Anne Bénard-Laribière团队研究了抗多巴胺能止吐药的使用与首次缺血性中风风险的相关性。2022年3月23日出版的《英国医学杂志》发表了该项成果。
为了评估与使用抗多巴胺能止吐药（ADA）相关的缺血性卒中风险，研究组使用法国全国报销医疗系统数据库（SNDS）的数据，进行了一项病例-时间-对照研究。符合条件的参与者年龄≥18岁，2012至2016年间首次缺血性卒中，卒中前70天内至少有一次ADA报销。
比较每位患者在风险期（中风前-14至-1天）和三个匹配参考期（-70至-57天、-56至-43天和-42至-29天）的ADA报销频率。ADA使用的时间趋势通过21859名随机选择的无事件对照组进行控制，这些人根据年龄、性别和缺血性卒中的危险因素与卒中患者进行单独匹配。
ADA的使用与缺血性卒中风险之间的相关性通过评估卒中患者和对照组暴露的优势比来评估。根据时变混杂因素（抗凝剂、抗血小板和血栓前或血管收缩药物）来进行校正分析。
在2612例确诊为偶发性卒中的患者中，1250例在风险期接受ADA，1060例在参考期接受ADA。与同期接受ADA的5128名和13165名对照组相比，校正后的优势比为3.12。按年龄、性别和痴呆病史分层的分析显示了类似的结果。根据ADA分层分析的校正后优势比比率，多潘立酮为2.51，美托哌丙嗪为3.62，甲氧氯普胺为3.53。敏感性分析表明，在使用的第一天风险会更高。
研究结果表明，近期使用ADA后缺血性卒中风险增加，其中美托哌丙嗪和甲氧氯普胺的增幅最高。
附：英文原文
Title: Risk of first ischaemic stroke and use of antidopaminergic antiemetics: nationwide case-time-control study
Author: Anne Bénard-Laribière, Emilie Hucteau, Stéphanie Debette, Julien Kirchgesner, Julien Bezin, Antoine Pariente
Issue&Volume: 2022/03/23
Abstract:
Objective To estimate the risk of ischaemic stroke associated with antidopaminergic antiemetic (ADA) use.
Design Case-time-control study.
Setting Data from the nationwide French reimbursement healthcare system database Système National des Données de Santé (SNDS).
Participants Eligible participants were ≥18 years with a first ischaemic stroke between 2012 and 2016 and at least one reimbursement for any ADA in the 70 days before stroke. Frequencies of ADA reimbursements were compared for a risk period (days -14 to -1 before stroke) and three matched reference periods (days -70 to -57, -56 to -43, and -42 to -29) for each patient. Time trend of ADA use was controlled by using a control group of 21859 randomly selected people free of the event who were individually matched to patients with stroke according to age, sex, and risk factors of ischaemic stroke.
Main outcome measures Association between ADA use and risk of ischaemic stroke was assessed by estimating the ratio of the odds ratios of exposure evaluated in patients with stroke and in controls. Analyses were adjusted for time varying confounders (anticoagulants, antiplatelets, and prothrombotic or vasoconstrictive drugs).
Results Among the 2612 patients identified with incident stroke, 1250 received an ADA in the risk period and 1060 in the reference periods. The comparison with the 5128 and 13165 controls who received an ADA in the same periods yielded a ratio of adjusted odds ratios of 3.12 (95% confidence interval 2.85 to 3.42). Analyses stratified by age, sex, and history of dementia showed similar results. Ratio of adjusted odds ratios for analyses stratified by ADA was 2.51 (2.18 to 2.88) for domperidone, 3.62 (3.11 to 4.23) for metopimazine, and 3.53 (2.62 to 4.76) for metoclopramide. Sensitivity analyses suggested the risk would be higher in the first days of use.
Conclusions Using French nationwide exhaustive reimbursement data, this self-controlled study reported an increased risk of ischaemic stroke with recent ADA use. The highest increase was found for metopimazine and metoclopramide.
DOI: 10.1136/bmj-2021-066192
Source: https://www.bmj.com/content/376/bmj-2021-066192
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
官方网址：http://www.bmj.com/
投稿链接：https://mc.manuscriptcentral.com/bmj
本期文章：《英国医学杂志》：Online/在线发表
