药物治疗注意缺陷多动障碍对身体损伤的有效性：观察性研究的系统评价和荟萃分析。
Effectiveness of Pharmacological Treatment for Attention-Deficit/Hyperactivity Disorder on Physical Injuries: A Systematic Review and Meta-Analysis of Observational Studies.
机构信息
Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China.
Department of Social Work and Social Administration, Faculty of Social Science, The University of Hong Kong, Hong Kong, China.
出版信息
CNS Drugs. 2017 Dec;31(12):1043-1055. doi: 10.1007/s40263-017-0485-1.
BACKGROUND
Patients with attention-deficit/hyperactivity disorder (ADHD) are more prone to physical injuries, including motor vehicle accidents, fractures and brain injuries. Several observational studies have been published investigating the association between the use of pharmacological treatment for ADHD and the incidence of physical injuries among patients with ADHD; however, the findings are not concordant.
OBJECTIVE
This study is a systematic review and meta-analysis of the existing literature and estimates the overall association between the use of ADHD medications and physical injury. Injury is defined as medically attended physical injuries in the form of hospitalisations, emergency department visits or general practitioners visits.
METHODS
The PubMed, EMBASE, PsycINFO, CINAHL and Cochrane Review databases were searched for relevant studies published up to May 2017 relating to ADHD medication and risk of injuries. Observational studies with any study design, all age groups (children and adults) and all ADHD medications (stimulant and non-stimulants) were included. Studies relevant to the association between ADHD medication exposure and risk of injuries in ADHD patients were extracted and compiled for meta-analysis. Both within-individual and between-individual analyses were conducted.
RESULTS
Overall, 2001 citations were identified and 10 observational studies were included. Three self-controlled case series and two self-controlled cohorts were eligible for meta-analysis of within-individual studies. Five cohort studies were included in the meta-analysis of between-individual studies. The adjusted rate ratio of the within-individual methods was 0.76 (95% confidence interval [CI] 0.61-0.93) and 0.88 (95% CI 0.85-0.92) for between-individual studies.
CONCLUSION
The findings of this meta-analysis support a reduced risk of injuries among ADHD patients who were treated with ADHD medications.
背景
患有注意力缺陷多动障碍（ADHD）的患者更容易发生身体损伤，包括机动车事故、骨折和脑损伤。已经发表了几项观察性研究，调查了 ADHD 药物治疗与 ADHD 患者身体损伤发生率之间的关系；然而，这些发现并不一致。
目的
本研究是对现有文献的系统评价和荟萃分析，评估 ADHD 药物治疗与身体损伤之间的总体相关性。损伤定义为以住院、急诊就诊或全科医生就诊形式出现的经医疗诊治的身体损伤。
方法
检索了 PubMed、EMBASE、PsycINFO、CINAHL 和 Cochrane Review 数据库，以查找截至 2017 年 5 月发表的与 ADHD 药物和损伤风险相关的研究。纳入了任何研究设计、所有年龄组（儿童和成人）和所有 ADHD 药物（兴奋剂和非兴奋剂）的观察性研究。提取并编译了与 ADHD 药物暴露与 ADHD 患者损伤风险之间的关联相关的研究，以进行荟萃分析。进行了个体内和个体间分析。
结果
共确定了 2001 条引文，纳入了 10 项观察性研究。有 3 项自身对照病例系列研究和 2 项自身对照队列研究符合个体内荟萃分析的条件。有 5 项队列研究纳入了个体间荟萃分析。个体内方法的调整后率比为 0.76（95%置信区间 [CI] 0.61-0.93），个体间研究的调整后率比为 0.88（95% CI 0.85-0.92）。
结论
荟萃分析的结果支持 ADHD 患者接受 ADHD 药物治疗后损伤风险降低。
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