Table_2_Antidepressants Usage and Risk of Pneumonia Among Elderly Patients With the Parkinson's Disease: A Population-Based Case-Control Study.pdf

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 [aOR] = 0.86, 95% CI = 0.82–0.90) and recent users (aOR = 0.83, 95% CI = 0.80–0.87). In terms of MAOIs users, current users had a lower risk of incident pneumonia (aOR = 0.88, 95% CI = 0.83–0.93), recent users (aOR = 0.89, 95% CI = 0.85–0.93). In terms of SSRIs users, current users had a higher risk of incident pneumonia (a OR = 1.13, 95% CI = 1.01–1.17), recent users (aOR = 1.01, 95% CI = 1.06–1.13), and past users (aOR = 1.19, 95% CI = 1.17–1.21). In terms of SNRIs users, past users had a higher risk of incident pneumonia (aOR = 1.07, 95% CI = 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（Parkinson's disease, PD）患者罹患肺炎的风险显著升高。抗抑郁药具有不同程度的抗胆碱能作用，且各类抗抑郁药对免疫功能的影响亦存在异质性。目前，老年帕金森病患者的肺炎发病风险与抗抑郁药使用之间的关联尚不明确。本研究旨在探讨老年帕金森病患者使用抗抑郁药与肺炎风险的相关性。
本项病例对照研究（case-control study）基于中国台湾地区纵向健康保险数据库的数据，分析了2002年至2018年间551975例老年帕金森病患者的临床资料。为减少非实验研究设计中协变量不平衡带来的潜在混杂偏倚，本研究采用倾向得分匹配法（propensity score matching）纳入无肺炎病史的老年患者作为对照。
本研究涉及的抗抑郁药包括三环类抗抑郁药（tricyclic antidepressants, TCAs）、单胺氧化酶抑制剂（monoamine oxidase inhibitors, MAOIs）、选择性5-羟色胺再摄取抑制剂（selective serotonin reuptake inhibitors, SSRIs）以及5-羟色胺和去甲肾上腺素再摄取抑制剂（serotonin and norepinephrine reuptake inhibitors, SNRIs）。
本研究采用条件logistic回归模型分析抗抑郁药使用与肺炎的关联，纳入的控制变量包括性别、年龄、收入水平、城市化水平、查尔森合并症指数（Charlson comorbidity index）评分以及与肺炎相关的合并症。
分析结果显示：与未使用者相比，三环类抗抑郁药当前使用者的新发肺炎风险更低（校正比值比（adjusted odds ratio, aOR）=0.86，95%置信区间（confidence interval, CI）=0.82~0.90），近期使用者风险亦显著降低（aOR=0.83，95%CI=0.80~0.87）；单胺氧化酶抑制剂当前使用者的新发肺炎风险更低（aOR=0.88，95%CI=0.83~0.93），近期使用者风险同样降低（aOR=0.89，95%CI=0.85~0.93）；选择性5-羟色胺再摄取抑制剂当前使用者的新发肺炎风险更高（aOR=1.13，95%CI=1.01~1.17），近期使用者（aOR=1.01，95%CI=1.06~1.13）及既往使用者（aOR=1.19，95%CI=1.17~1.21）的发病风险均升高；5-羟色胺和去甲肾上腺素再摄取抑制剂既往使用者的新发肺炎风险更高（aOR=1.07，95%CI=1.03~1.10）。
综上，不同类别抗抑郁药的使用与新发肺炎风险存在显著关联。使用三环类抗抑郁药（如阿米替林、丙米嗪）可降低新发肺炎的发生风险；近期使用单胺氧化酶抑制剂（如司来吉兰、雷沙吉兰）可降低肺炎发病风险；而使用选择性5-羟色胺再摄取抑制剂（如氟西汀、舍曲林、艾司西酞普兰、帕罗西汀、西酞普兰）以及5-羟色胺和去甲肾上腺素再摄取抑制剂（如米那普仑、文拉法辛）则会升高新发肺炎的发生风险。