Hubbard R, Venn A, Britton J
Division of Respiratory Medicine, Nottingham University, UK.
Eur Respir J. 2000 Sep;16(3):409-13. doi: 10.1034/j.1399-3003.2000.016003409.x.
The explanations for the emergence of cryptogenic fibrosing alveolitis as a new clinical entity during the second half of the 20th century are unclear. The authors have previously reported evidence of an increased risk of cryptogenic fibrosing alveolitis in relation to the use of antidepressant drugs. The authors have now tested this hypothesis a priori in an analysis of computerized general practice records for 890 cases of cryptogenic fibrosing alveolitis and 5,884 matched controls drawn from the UK General Practice Research Database. Exposure to antidepressants at the time of diagnosis was increased in cases compared to controls (odds ratio (OR) 1.52, 95% confidence interval (95% CI) 1.24-1.86), and this increase remained if the analysis was restricted to exposures 4 yrs prior to diagnosis (OR 1.50, 95% CI 0.98-2.30). However this increased prescribing was not specific to any particular class of antidepressant or individual drug, and there was no evidence of a dose-response relationship between exposure to amitriptyline (the most commonly prescribed antidepressant) and disease. The presented data do not allow any firm conclusion to be made as to whether there is a causal relationship between antidepressant exposure and cryptogenic fibrosing alveolitis, but it seems unlikely that exposure to tricyclic antidepressants shortly before diagnosis is a strong risk factor for cryptogenic fibrosing alveolitis.
隐源性纤维性肺泡炎作为一种新的临床病症在20世纪后半叶出现的原因尚不清楚。作者此前曾报告过使用抗抑郁药物会增加患隐源性纤维性肺泡炎风险的证据。作者现在通过对英国全科医学研究数据库中890例隐源性纤维性肺泡炎病例和5884例匹配对照的计算机化全科医疗记录进行分析，对这一假设进行了先验检验。与对照组相比，病例在诊断时使用抗抑郁药物的比例有所增加（比值比（OR）为1.52，95%置信区间（95%CI）为1.24 - 1.86），如果将分析限制在诊断前4年的用药情况，这一增加仍然存在（OR为1.50，95%CI为0.98 - 2.30）。然而，这种用药增加并非特定于任何一类抗抑郁药物或个别药物，并且没有证据表明使用阿米替林（最常用的抗抑郁药物）与疾病之间存在剂量反应关系。所呈现的数据无法就抗抑郁药物暴露与隐源性纤维性肺泡炎之间是否存在因果关系得出任何确凿结论，但在诊断前不久使用三环类抗抑郁药物似乎不太可能是隐源性纤维性肺泡炎的一个强风险因素。
