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目的探讨抗精神病药物的暴露与静脉血栓栓塞症及肺栓塞发生风险的关系,为有抗精神病药物暴露者预防静脉血栓栓塞症及肺栓塞的发生提供循证医学证据。方法计算机检索Pub Med、Web of Science、CNKI、VIP和Elsevier数据库,搜集抗精神病药物暴露与静脉血栓栓塞症及肺栓塞风险相关性的病例-对照和队列研究,检索时限为从各数据库建库至2016年7月。由2名研究员独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用Stata 12.0软件进行Meta分析。结果纳入19篇文献。Meta分析结果显示:有抗精神病药物暴露史的患者静脉血栓栓塞症发生风险高于无暴露者[OR=1.50,95%CI(1.30,1.74),P<0.001],暴露于低效价[OR=2.28,95%CI(1.02,5.10),P=0.045]和高效价[OR=1.68,95%CI(1.37,2.05),P<0.001]的第一代抗精神病药物及第二代抗精神病药物[OR=1.74,95%CI(1.24,2.44),P=0.001]均会增加静脉血栓栓塞症发生的风险。抗精神病药物暴露会增加肺栓塞的发生风险[OR=3.69,95%CI(1.23,11.07),P=0.02],其中,第一代抗精神病药物暴露明显增加肺栓塞的发生风险[OR=2.54,95%CI(1.22,5.32),P=0.013],而第二代抗精神病药物的暴露未发现会增加肺栓塞的风险。结论不管是低效价、高效价的第一代抗精神病药物,还是第二代抗精神病药物均会导致静脉血栓栓塞症的发生风险增加。同时,第一代抗精神病药物的暴露还会增加肺栓塞的发生风险。因此,服用抗精神病药物时应注意监测静脉血栓栓塞症及肺栓塞的发生。
Objective To explore the relationship between antipsychotic exposure and venous thromboembolism and the risk of pulmonary embolism, and to provide evidence-based medical evidence for the prevention of venous thromboembolism and pulmonary embolism in anti-psychotic drug exposed persons. Methods The databases of Pub Med, Web of Science, CNKI, VIP and Elsevier were searched by computer to collect case-control and cohort studies on the correlation between antipsychotic exposure and venous thromboembolism risk and pulmonary embolism. The search time was from database building to July 2016. Two researchers independently screened the literature, extracted data, and assessed the risk of bias included in the study. Meta-analysis was performed using Stata 12.0 software. Results included 19 articles. Meta-analysis showed that the risk of venous thromboembolism in patients with history of antipsychotic exposure was higher than those without exposure [OR = 1.50, 95% CI (1.30, 1.74), P <0.001] = 2.28, 95% CI (1.02, 5.10), P = 0.045], and first generation antipsychotics with high titer [OR = 1.68,95% CI (1.37,2.05), P <0.001] Drugs [OR = 1.74, 95% CI (1.24, 2.44), P = 0.001] all increased the risk of venous thromboembolism. Exposure to antipsychotics increased the risk of pulmonary embolism (OR = 3.69, 95% CI 1.23, 11.07, P = .02). Exposure to first-generation antipsychotics significantly increased the risk of pulmonary embolism (OR = 2.54 , 95% CI (1.22,5.32), P = 0.013], whereas exposure to second-generation antipsychotics was found not to increase the risk of pulmonary embolism. Conclusions Both the first-generation antipsychotics of low potency and high titer, and the second-generation antipsychotics lead to an increased risk of venous thromboembolism. At the same time, exposure to the first generation of antipsychotics increases the risk of pulmonary embolism. Therefore, taking antipsychotics should pay attention to monitoring venous thromboembolism and pulmonary embolism.