三环类抗抑郁药和/或γ-氨基丁酸类似物的使用与糖尿病周围神经病变患者的跌倒风险相关。
Tricyclic Antidepressant and/or γ-Aminobutyric Acid-Analog Use Is Associated With Fall Risk in Diabetic Peripheral Neuropathy.
机构信息
Sealy Center on Aging, University of Texas Medical Branch, Galveston, Texas.
Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, Texas.
出版信息
J Am Geriatr Soc. 2019 Jun;67(6):1174-1181. doi: 10.1111/jgs.15779. Epub 2019 Jan 29.
BACKGROUND/OBJECTIVES: Peripheral neuropathy is a common diabetes complication that can increase fall risk. Regarding fall risk, the impact of pain management using tricyclic antidepressants (TCAs) or γ-aminobutyric acid (GABA) analogs is unclear because these medications can also cause falls. This study investigates the impact of these drugs on fall and fracture risk in older diabetic peripheral neuropathy (DPN) patients.
DESIGN
Historical cohort study with 1-to-1 propensity matching of TCA/GABA-analog users and nonusers.
SETTING
Nationally representative 5% Medicare sample between the years 2008 and 2010.
PARTICIPANTS
After applying all selection criteria, 5,550 patients with prescription and 22,200 patients without prescription of TCAs/GABA-analogs were identified. Both patient groups were then stratified for fall history and matched based on propensity of receiving TCAs/GABA-analogs within each group.
MEASUREMENTS
Patients were followed until the first incidence of fall or the first incidence of fracture during the follow-up period (for up to 5 years).
RESULTS
After matching, users and nonusers were largely similar. After covariate adjustment, TCA/GABA-analog use was associated with a statistically significant increase in fall risk (adjusted hazard ratio [HR] = 1.11; 95% confidence interval [CI] = 1.03-1.20), but was not associated with fracture risk (adjusted HR = 1.09; 95% CI = 0.99-1.19) in the conventional analysis. Treating TCA/GABA-analog use as a time-dependent covariate resulted in statistically significant associations of TCA/GABA-analog use with both fall and fracture risk (HR = 1.26 [95% CI = 1.17-1.36]; and HR = 1.12 [95% CI = 1.02-1.24], respectively).
CONCLUSION
Among older patients with DPN, GABA-analogs or TCAs increase fall risk and possibly fracture risk. Use of these medications is therefore a potentially modifiable risk factor for falls and fractures in this population.
背景/目的：周围神经病变是一种常见的糖尿病并发症，会增加跌倒风险。关于跌倒风险，使用三环类抗抑郁药（TCAs）或γ-氨基丁酸（GABA）类似物进行疼痛管理的影响尚不清楚，因为这些药物也会导致跌倒。本研究旨在调查这些药物对老年糖尿病周围神经病变（DPN）患者跌倒和骨折风险的影响。
设计
TCAs/GABA 类似物使用者和非使用者的 1:1 倾向匹配的历史性队列研究。
设置
2008 年至 2010 年全国代表性的 5%医疗保险样本。
参与者
在应用所有选择标准后，确定了 5550 名有 TCA/GABA 类似物处方和 22200 名无 TCA/GABA 类似物处方的患者。然后根据每个组内接受 TCA/GABA 类似物的倾向，对两组患者进行分层并进行匹配。
测量
患者在随访期间（最长 5 年）直至首次发生跌倒或首次发生骨折。
结果
匹配后，使用者和非使用者在很大程度上相似。调整协变量后，TCA/GABA 类似物的使用与跌倒风险显著增加相关（调整后的危害比 [HR] = 1.11；95%置信区间 [CI] = 1.03-1.20），但与骨折风险无关（调整后的 HR = 1.09；95% CI = 0.99-1.19）在常规分析中。将 TCA/GABA 类似物的使用视为时间依赖性协变量，结果表明 TCA/GABA 类似物的使用与跌倒和骨折风险均具有统计学显著关联（HR = 1.26 [95% CI = 1.17-1.36]；和 HR = 1.12 [95% CI = 1.02-1.24]）。
结论
在老年 DPN 患者中，GABA 类似物或 TCAs 会增加跌倒风险，并可能增加骨折风险。因此，在该人群中，使用这些药物可能是跌倒和骨折的一个潜在可改变的危险因素。
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