使用抗憂鬱藥物對中風復發之相關性研究

Abstract

背景：過去研究服用抗憂鬱藥物與中風復發之相關性的結果還尚未清楚。本篇研究將評估中風病患服用抗憂鬱藥物是否會增加中風復發之風險。 方法：本篇的世代研究追蹤了在2000年到2009年台灣健康保險資料庫中18884名年齡20歲以上的中風(包含出血性與缺血性中風)初發患者。在追蹤期間每一個病人的抗憂鬱藥物處方之紀錄被取得，並且抗憂鬱藥物之種類以解剖學治療學及化學分類系統的定義分類：三環類的抗憂鬱藥物(tricyclic antidepressants, TCAs)、選擇性血清素再吸收抑制劑(selective serotonin reuptake inhibitors, SSRIs)、單胺氧化酶抑制劑(monoamine oxidase inhibitors, MAOIs)及其他。研究所追蹤的結果為在追蹤期間發生中風復發。研究分析使用時間相依的Cox 比例風險迴歸模型。 結果：在61892人年的追蹤期間，有4450個中風復發事件發生。在調整其他變項後，服用抗憂鬱藥物會增加中風復發風險(風險比值(hazard ratio [HR]), 1.41; 95%信賴區間(95% confidence interval [CI]), 1.24-1.61)，尤其是缺血性中風(HR, 1.47; 95% CI, 1.28-1.68)，而出血性中風則無(HR, 1.23; 95% CI, 0.89-1.71)。使用抗憂鬱藥物種類中的TCAs (HR, 1.52; 95% CI, 1.24-1.87)、其他分類(HR, 1.42; 95% CI, 1.12-1.80)、或是多重種類一起(HR, 1.87; 95% CI, 1.06-3.30)使用時會使中風復發風險增加。 結論：使用抗憂鬱藥物會增加中風復發之風險，特別是缺血性中風，未來需要有更多研究來了解其中的生理機轉。

Background - The evidence about the association between use of antidepressants and stroke recurrence was scanty. This study evaluated the risk of stroke recurrence of using antidepressants in patients with stroke from a national representative cohort. Methods – This cohort study followed 18884 patients aged 20 years who had an incident stroke from 2000 to 2009 from National Health Insurance Research Database in Taiwan. Records of each antidepressant prescription were obtained during follow-up. The types of antidepressants were categorized by Anatomical Therapeutic Chemical classification system: tricyclic antidepressants (TCAs), selective serotonin reuptake inhibitors (SSRIs), monoamine oxidase inhibitors (MAOIs), and other antidepressants. The main outcome was a recurrent stroke during the follow-up period. A time-dependent Cox proportional hazards model was used in the analyses. Results – During 61892 person-years of follow-up, we documented 4450 events for stroke recurrence. Antidepressants use was associated with an increased risk of stroke recurrence (adjusted hazard ratio [HR], 1.41; 95% confidence interval [CI], 1.24-1.61]), especially in ischemic stroke (HR, 1.47; 95% CI, 1.28-1.68), but not in hemorrhagic stroke (HR, 1.23; 95% CI, 0.89-1.71). The increased risk for stoke recurrence was found in TCAs (HR, 1.52; 95% CI, 1.24-1.87), the group of other types (HR, 1.42; 95% CI, 1.12-1.80), or multiple types (HR, 1.87; 95% CI, 1.06-3.30). Conclusions – We demonstrated that use of antidepressants was associated with an increased risk of stroke recurrence, especially in ischemic stroke among Taiwanese. Further studies are warranted to confirm the possible underlying mechanisms of these findings.