抗精神病药与肺炎发病风险关系的Meta分析

Meta Analysis of the Relation Between Antipsychotic Drug and the Risk of Pneumonia

目的通过Meta分析探讨抗精神病药与肺炎发病风险的关系,为有抗精神病药暴露史者预防肺炎的发生提供循证医学证据。方法计算机检索Pub Med、Web of Science、OVID、Elsevier、中国知网、万方数据库,检索时限为从各数据库建库至2015年7月。由2名研究员采用纽卡斯尔-渥太华质量评价量表(NOS)独立对纳入文献进行方法学质量评价并提取文献资料,主要包括第一作者、发表时间、地域、研究类型、年龄、校正因素、样本量、结局、效应值。结果纳入6篇文献,共计42 069例研究对象,NOS评分均>5分。合并病例对照研究的Meta分析显示,有第一代抗精神病药(FGA)暴露史的患者肺炎发病风险高于无FGA暴露史者〔OR=1.73,95%CI(1.49,2.00),P<0.01〕,有第二代抗精神病药(SGA)暴露史者肺炎发病风险高于无SGA暴露史者〔OR=1.92,95%CI(1.68,2.19),P<0.001〕。按研究对象年龄(≥65岁和<65岁)、研究类型(病例对照研究和队列研究)及地域(中国台湾和其他)进行的亚组分析结果显示,各亚组有FGA、SGA暴露史者较无FGA、SGA暴露史者肺炎发病风险增加,差异有统计学意义(P<0.001)。结论 FGA、SGA可增加肺炎的发病风险,服用抗精神病药时应注意监测肺炎的发生。

Objective To investigate the association between antipsychotic drug exposure and the risk of pneumonia by meta analysis. Methods A computer- based retrieval was made on Pub Med,Web of Science,OVID,Elsevier,CNKI and Wanfang database with a time range from database establishment to July 2015. Two researchers separately conducted methodological quality evaluation using Newcastle- Ottawa Scale（ NOS） and extrated data which mainly included the first author,publication time,region,research type,age,adjusting factors,sample size,outcome and effect size. Results We included 6 pieces of literatures and 42 069 research subjects,and NOS score of each literature was over 5. Meta analysis of combined case- control study showed that patients with history of FGA exposure had higher risk of pneumonia than patients without history of FGA exposure 〔OR = 1. 73,95% CI（ 1. 49,2. 00）,P〈0. 001〕,and patients with history of SGA exposure had higher risk of pneumonia than patients without history of SGA exposure 〔OR = 1. 92,95% CI（ 1. 68,2. 19）, P〈0. 001 〕. Subgroup analysis based on age（ ≥65 and 65）,research type（ case- control study and cohort study） and region（ Chinese Taipei and others） showed that patients with history of FGA and SGA exposure had higher risk of pneumonia than patients without history of FGA and SGA exposure（ P〈0. 001）. Conclusion FGA and SGA increase the risk of pneumonia, and the occurrence of pneumonia should be monitored when taking antipsychotic drug.