Kuo Wei-Yin, Huang Kuang-Hua, Kuan Yu-Hsiang, Chang Yu-Chia, Tsai Tung-Han, Lee Chien-Ying
Department of Health Services Administration, China Medical University, Taichung, Taiwan.
Department of Pharmacology, Chung Shan Medical University, Taichung, Taiwan.
Front Med (Lausanne). 2022 Feb 18;9:740182. doi: 10.3389/fmed.2022.740182. eCollection 2022.
The patients with Parkinson's disease (PD) are associated with a higher risk of pneumonia. Antidepressants exert an anticholinergic effect in varying degrees and various classes of antidepressants also can produce a different effect on immune function. The relationship between the risk of pneumonia and the use of antidepressants among elderly patients with PD is unknown. The study investigated the risk of pneumonia associated with the use of antidepressants in elderly patients with PD. This case-control study was based on data from the longitudinal health insurance database in Taiwan. We analyzed the data of 551,975 elderly patients with PD between 2002 and 2018. To reduce the potential confounding caused by unbalanced covariates in non-experimental settings, we used propensity score matching to include older patients without pneumonia to serve as the comparison. The antidepressants in the study included tricyclic antidepressants (TCAs), monoamine oxidase inhibitors (MAOIs), selective serotonin reuptake inhibitors (SSRIs), serotonin, and norepinephrine reuptake inhibitors (SNRIs). The conditional logistic regression was used to investigate the association between antidepressants and pneumonia. Control variables in the study included sex, age, income level, urbanization, Charlson comorbidity index score, and comorbidities related to pneumonia. In terms of TCAs users, compared with patients not receiving TCAs, current users had a lower risk of incident pneumonia (adjusted odds ratio [] = 0.86, 95% = 0.82-0.90) and recent users (a = 0.83, 95% = 0.80-0.87). In terms of MAOIs users, current users had a lower risk of incident pneumonia (a = 0.88, 95% = 0.83-0.93), recent users (a = 0.89, 95% = 0.85-0.93). In terms of SSRIs users, current users had a higher risk of incident pneumonia (a = 1.13, 95% = 1.01-1.17), recent users (a = 1.01, 95% = 1.06-1.13), and past users (a = 1.19, 95% = 1.17-1.21). In terms of SNRIs users, past users had a higher risk of incident pneumonia (a = 1.07, 95% = 1.03-1.10). The incident pneumonia is associated with the use of individuals of different classes of antidepressants. The use of TCAs (such as, amitriptyline and imipramine) had a lower odds of incident pneumonia. The use of MAOIs (such as, selegiline and rasagiline) had a lower odds of pneumonia during recent use. The use of SSRIs (such as, fluoxetine, sertraline, escitalopram, paroxetine, and citalopram) and SNRIs (such as, milnacipran, and venlafaxine) had a higher odds of incident pneumonia.
帕金森病（PD）患者患肺炎的风险较高。抗抑郁药具有不同程度的抗胆碱能作用，并且各类抗抑郁药对免疫功能也会产生不同影响。老年PD患者中肺炎风险与抗抑郁药使用之间的关系尚不清楚。该研究调查了老年PD患者使用抗抑郁药与肺炎发生风险之间的关系。这项病例对照研究基于台湾纵向健康保险数据库的数据。我们分析了2002年至2018年间551975名老年PD患者的数据。为减少非实验环境中协变量不平衡导致的潜在混杂因素，我们使用倾向得分匹配法纳入无肺炎的老年患者作为对照。研究中的抗抑郁药包括三环类抗抑郁药（TCAs）、单胺氧化酶抑制剂（MAOIs）、选择性5-羟色胺再摄取抑制剂（SSRIs）、5-羟色胺及去甲肾上腺素再摄取抑制剂（SNRIs）。采用条件逻辑回归分析抗抑郁药与肺炎之间的关联。研究中的对照变量包括性别、年龄、收入水平、城市化程度、查尔森合并症指数评分以及与肺炎相关的合并症。就使用TCAs的患者而言，与未使用TCAs的患者相比，当前使用者发生肺炎的风险较低（调整优势比[]=0.86，95% =0.82 - 0.90），近期使用者也是如此（a =0.83，95% =0.80 - 0.87）。就使用MAOIs的患者而言，当前使用者发生肺炎的风险较低（a =0.88，95% =0.83 - 0.93），近期使用者也是如此（a =0.89，95% =0.85 - 0.93）。就使用SSRIs的患者而言，当前使用者发生肺炎的风险较高（a =1.13，95% =1.01 - 1.17），近期使用者也是如此（a =1.01，95% =1.06 - 1.13），既往使用者同样如此（a =1.19，95% =1.17 - 1.21）。就使用SNRIs的患者而言，既往使用者发生肺炎的风险较高（a =1.07，95% =1.03 - 1.10）。肺炎的发生与不同类别抗抑郁药的使用有关。使用TCAs（如阿米替林和丙咪嗪）发生肺炎的几率较低。使用MAOIs（如司来吉兰和雷沙吉兰）近期使用时患肺炎的几率较低。使用SSRIs（如氟西汀、舍曲林、艾司西酞普兰、帕罗西汀和西酞普兰）和SNRIs（如米那普明和文拉法辛）发生肺炎的几率较高。
