Department of Family Medicine, University of British Columbia and Island Medical Program, Victoria, BC.
Home Team Medical Services, Victoria, BC.
Clin Interv Aging. 2017 Nov 21;12:1977-1984. doi: 10.2147/CIA.S144263. eCollection 2017.
The association between interstitial lung disease (ILD) and selective serotonin reuptake inhibitors and serotonin norepinephrine reuptake inhibitors (SSRI/SNRI) has been previously described in published case reports. However, its prevalence may be more common than expected. We examined the association between SSRI/SNRI usage and presence of ILD and or bronchiectasis (ILD/B) in an elderly population.
We conducted a retrospective case series and case-control study involving all 296 eligible elderly patients in one primary care geriatric practice in Victoria, BC, Canada. Cases required the presence of ILD/B on computed tomography (CT) or chest X-ray (CXR). Cases were excluded if they had other causes for ILD/B on CXR or CT such as exposure to known pneumotoxic drugs, metastatic cancer, rheumatoid lung disease, sarcoidosis, previous pulmonary tuberculosis, or pneumoconiosis. Data were abstracted from the patients' medical record. The exposure variable was standardized cumulative person-month (p-m) dose of SSRI/SNRI. The study was approved by the Clinical Research Ethics Board of University of British Columbia with a waiver of informed consent.
A total of 12 cases and 273 controls were identified. Their mean ages were 89.0 and 88.7 years, respectively (=0.862). A total of 10/12 cases and 99/273 controls were exposed to SSRI/SNRI. The odds ratio was 8.79, 95% confidence interval 2.40-32.23 (=0.001). The median p-m exposure to SSRI/SNRI was 110.0 months for cases and 29.5 for controls (=0.003).
SSRIs and SNRIs were significantly associated with the risk of ILD/B in this elderly population. Because of their widespread usage, further studies should be done to validate these findings. Prescribers should cautiously monitor patients for development of insidious pulmonary symptoms when these drugs are used.
先前的已发表病例报告描述了间质性肺病（ILD）与选择性 5-羟色胺再摄取抑制剂和 5-羟色胺去甲肾上腺素再摄取抑制剂（SSRIs/SNRIs）之间的关联。然而，其发病率可能比预期的更为常见。我们在一个位于加拿大不列颠哥伦比亚省维多利亚市的初级保健老年病学实践中，对 SSRIs/SNRIs 使用与 ILD 和/或支气管扩张（ILD/B）之间的关联进行了回顾性病例系列和病例对照研究。
我们对 296 名符合条件的老年患者进行了回顾性病例系列和病例对照研究，这些患者均来自加拿大不列颠哥伦比亚省维多利亚市的一个初级保健老年病学实践。病例需要在 CT 或胸部 X 射线（CXR）上存在 ILD/B。如果 CXR 或 CT 上有其他原因导致 ILD/B，如已知的肺毒性药物暴露、转移性癌症、类风湿性肺病、结节病、既往肺结核或尘肺病，则排除病例。数据从患者的病历中提取。暴露变量是标准化的累积个体月（p-m）剂量的 SSRIs/SNRIs。本研究得到了不列颠哥伦比亚大学临床研究伦理委员会的批准，并豁免了知情同意。
共确定了 12 例病例和 273 例对照。他们的平均年龄分别为 89.0 和 88.7 岁（=0.862）。12 例病例中有 10 例和 273 例对照中有 99 例接触过 SSRIs/SNRIs。比值比为 8.79，95%置信区间为 2.40-32.23（=0.001）。病例的中位 p-m SSRIs/SNRIs 暴露量为 110.0 个月，而对照的暴露量为 29.5 个月（=0.003）。
在本老年人群中，SSRIs 和 SNRIs 与 ILD/B 的风险显著相关。由于它们的广泛使用，应进一步开展研究来验证这些发现。当使用这些药物时，临床医生应谨慎监测患者是否出现隐匿性肺部症状。
