异维 A 酸与精神障碍风险：一项为有争议故事提供新视角的全球研究。
Isotretinoin and the risk of psychiatric disturbances: A global study shedding new light on a debatable story.
机构信息
Lűbeck Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany; Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel; Unit of Dermatology and Skin Research Laboratory, Barch Padeh Medical Center, Poriya, Israel.
Lűbeck Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany; Department of Dermatology, University of Lübeck, Lübeck, Germany.
出版信息
J Am Acad Dermatol. 2023 Feb;88(2):388-394. doi: 10.1016/j.jaad.2022.10.031. Epub 2022 Oct 20.
INTRODUCTION
Isotretinoin-related risk of depression and suicidal behavior is a topic of inconclusiveness. A crucial knowledge gap exists in defining the association of isotretinoin with other psychiatric comorbidities.
OBJECTIVE
To evaluate the risk of psychiatric outcomes among patients with acne treated with isotretinoin versus oral antibiotics.
METHODS
A global population-based retrospective cohort study enrolled 2 groups of patients with acne managed by isotretinoin (n = 75,708) and oral antibiotics (n = 75,708). Patients were compared regarding the risk of 9 psychiatric outcomes.
RESULTS
Relative to those treated with oral antibiotics, patients prescribed isotretinoin experienced lower risk of depression (hazard ratio [HR], 0.90; 95% confidence interval [CI], 0.87-0.93; P < .001), but comparable risk of major depressive disorder (HR, 0.97; 95% CI, 0.92-1.03; P = .318). Risk of suicidal attempts was comparable between groups (HR, 0.97; 95% CI, 0.85-1.11; P = .663), despite the elevated risk of suicidal ideation in those under isotretinoin (HR, 1.41; 95% CI, 1.32-1.50; P < .001). Patients under isotretinoin had lower risk of post-traumatic stress disorder (HR, 0.75; 95% CI, 0.68-0.82; P < .001), anxiety (HR, 0.84; 95% CI, 0.82-0.87; P < .001), bipolar disorder (HR, 0.65; 95% CI, 0.59-0.72; P < .001), schizophrenia (HR, 0.60; 95% CI, 0.48-0.76; P < .001), and adjustment disorder (HR, 0.82; 95% CI, 0.77-0.87; P < .001).
LIMITATIONS
Retrospective data collection.
CONCLUSION
Isotretinoin confers lower risk of 6 psychiatric comorbidities and comparable risk of suicidal attempts.
简介
异维 A 酸相关抑郁和自杀行为的风险是一个尚无定论的话题。在定义异维 A 酸与其他精神共病的相关性方面，存在一个关键的知识空白。
目的
评估痤疮患者接受异维 A 酸治疗与口服抗生素治疗的精神结局风险。
方法
这项全球基于人群的回顾性队列研究纳入了接受异维 A 酸（n=75708）和口服抗生素（n=75708）治疗的两组痤疮患者。比较了两组患者 9 种精神结局的风险。
结果
与接受口服抗生素治疗的患者相比，接受异维 A 酸治疗的患者患抑郁症的风险较低（风险比[HR]，0.90；95%置信区间[CI]，0.87-0.93；P<.001），但患重度抑郁症的风险相似（HR，0.97；95%CI，0.92-1.03；P=0.318）。两组自杀未遂的风险相似（HR，0.97；95%CI，0.85-1.11；P=0.663），尽管异维 A 酸组自杀意念的风险升高（HR，1.41；95%CI，1.32-1.50；P<.001）。接受异维 A 酸治疗的患者患创伤后应激障碍（HR，0.75；95%CI，0.68-0.82；P<.001）、焦虑症（HR，0.84；95%CI，0.82-0.87；P<.001）、双相情感障碍（HR，0.65；95%CI，0.59-0.72；P<.001）、精神分裂症（HR，0.60；95%CI，0.48-0.76；P<.001）和适应障碍（HR，0.82；95%CI，0.77-0.87；P<.001）的风险较低。
局限性
回顾性数据收集。
结论
异维 A 酸可降低 6 种精神共病的风险，且自杀未遂的风险相似。
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