Upper Gastrointestinal Research, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
J Clin Psychopharmacol. 2012 Jun;32(3):336-40. doi: 10.1097/JCP.0b013e318253d71a.
Case reports have indicated an increased risk of acute pancreatitis during use of selective serotonin reuptake inhibitors (SSRIs), an association not found in a few epidemiological studies. We studied the use of SSRI in relation to risk of acute pancreatitis in a population-based case-control study of people aged 40 to 84 years between 2006 and 2008 in Sweden. The Patient Register was used to identify 6161 cases of first-episode acute pancreatitis. The Register of the Total Population was used to randomly select 61,637 control subjects from the general population using frequency-based density sampling, matched for age, sex, and calendar year. Use of SSRI was defined as "current," "recent," "past," or "former" if the drug had been dispensed 1 to 114 days, 115 to 180 days, 181 to 365 days, or 1 to 3.5 years before a given index date, respectively. Logistic regression with adjustment for potential confounding factors was used to calculate odds ratios (ORs) with 95% confidence intervals (CIs). The OR for acute pancreatitis, adjusted for matching variables, was increased among present users of SSRI (OR, 1.5; 95% CI, 1.4-1.7). After adjusting for diseases or medications related to alcohol overconsumption, tobacco smoking, diabetes, ischemic heart disease, obesity, and severe pain together with educational level and marital status, the corresponding OR was 1.1 (95% CI, 1.0-1.3). After adjusting for the number of distinct medications, a proxy for comorbidity, the corresponding OR was 1.0 (95% CI, 0.9-1.1). The OR for antidepressant use other than SSRI showed a similar pattern. In conclusion, no increased risk of acute pancreatitis remained among users of SSRI after adjusting for confounding factors.
病例报告表明，选择性 5-羟色胺再摄取抑制剂（SSRIs）的使用会增加急性胰腺炎的风险，而少数流行病学研究并未发现这种关联。我们在瑞典进行了一项基于人群的病例对照研究，该研究在 2006 年至 2008 年间对 40 至 84 岁的人群进行了研究，以评估 SSRI 的使用与急性胰腺炎风险之间的关系。患者登记处用于识别首次发作的急性胰腺炎病例 6161 例。总人口登记处用于基于频率密度抽样从普通人群中随机选择 61637 名对照者，年龄、性别和日历年份相匹配。如果药物在给定的索引日期前 1 至 114 天、115 至 180 天、181 至 365 天或 1 至 3.5 年内配药，则将 SSRI 的使用定义为“当前”、“近期”、“过去”或“以前”。使用调整潜在混杂因素的逻辑回归计算比值比（OR）及其 95%置信区间（CI）。在调整了匹配变量后，当前使用 SSRIs 的患者发生急性胰腺炎的 OR 为 1.5（95%CI，1.4-1.7）。在调整了与酒精过度摄入、吸烟、糖尿病、缺血性心脏病、肥胖和剧烈疼痛相关的疾病或药物以及教育水平和婚姻状况后，相应的 OR 为 1.1（95%CI，1.0-1.3）。在调整了特定药物数量（一种混杂因素的替代指标）后，相应的 OR 为 1.0（95%CI，0.9-1.1）。使用除 SSRIs 以外的抗抑郁药的 OR 也呈现出类似的模式。总之，在调整了混杂因素后，SSRIs 的使用者发生急性胰腺炎的风险并未增加。
