Thorax：苯二氮卓类药物暴露与肺炎危险增加相关

　　英国学者的一项研究发现，苯二氮卓类药物与社区获得性肺炎（CAP）及CAP导致的患者死亡危险增加相关。研究提示苯二氮卓类药物的免疫安全性尚需更深入的研究。论文2012年12月5日在线发表于《胸腔》（Thorax）杂志。

　　既往研究发现，苯二氮卓类药物应用与危重病患者感染发生率及其脓毒血症死亡率增加相关。该研究旨在确定在社区应用苯二氮卓类药物对肺炎发生率及随后死亡率的影响。

　　该巢式病例对照研究从英国初级保健患者数据库（2001年至2002年）中将29 697名受试者纳入对照组，4964例纳入CAP组，利用Cox回规模型确定CAP患者应用苯二氮卓类药物对死亡的影响。结果校正OR值、HR和95%可信区间（CI）。

　　结果显示，苯二氮卓类药物暴露与肺炎危险增加相关（OR 为1.54，95% CI 1.42—1.67）。单个药物如地西泮（diazepam）、劳拉西泮（lorazepam）和替马西泮（temazepam）与CAP发生危险增加相关，未发现氯氮卓有上述相关性。同时，苯二氮卓类药物应用与患者诊断CAP之前30天的死亡率和长期死亡率增加相关【HR分别为1.22和1.32；前者95% CI（1.06 —1.39），后者95% CI 1.19 —1.47】。单个药物如地西泮、氯氮卓、劳拉西泮和替马西泮均可影响CAP患者的长期死亡率。、

与苯二氮卓相关的拓展阅读：

• Thorax：苯二氮卓类药物暴露与肺炎危险增加相关
• [AES 2012]全新苯二氮卓类制剂治疗癫痫反复发作
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The impact of benzodiazepines on occurrence of pneumonia and mortality from pneumonia: a nested case-control and survival analysis in a population-based cohort

Objectives 

Benzodiazepines have been associated with an increased incidence of infections, and mortality from sepsis, in the critically ill. Here, we determined the effect of community use of benzodiazepines on the occurrence of, and mortality following, pneumonia.

Methods 

A nested case-control study using 29697 controls and 4964 cases of community-acquired pneumonia (CAP) from The Health Improvement Network, a UK primary care patient database (2001–2002), investigated the association between benzodiazepines and pneumonia occurrence using conditional logistic regression. Cox regression was then used to determine the impact of benzodiazepines on mortality in the 4964 cases of CAP. Results are presented as adjusted OR, adjusted HR and 95% CI.

Results 

Exposure to benzodiazepines was associated with an increased risk of pneumonia (OR 1.54, 95% CI 1.42 to 1.67). Individually diazepam, lorazepam and temazepam, but not chlordiazepoxide, were associated with an increased incidence of CAP. As a class, benzodiazepines were associated with increased 30-day (HR 1.22 (95% CI 1.06 to 1.39)) and long-term mortality (HR 1.32 (95% CI 1.19 to 1.47)) in patients with a prior diagnosis of CAP. Individually diazepam, chlordiazepoxide, lorazepam and temazepam affected long-term mortality in these patients.

Conclusions 

Benzodiazepines were associated with an increased risk of, and mortality from, CAP. These hypothesis generating data suggest further research is required into the immune safety profile of benzodiazepines.