Lancet Psychiatry:精神障碍、情绪障碍患者应优先接种COVID-19疫苗

2021-07-19 MedSci原创 MedSci原创

应考虑对所有该研究中确定的高危患者优先接种疫苗。此外,需要对出现COVID-19的精神障碍患者进行密切监测和适当的医院转诊,以抵消可能减少的治疗机会。

据世卫组织统计,截至2021年5月22日,已报告1.66亿例COVID-19确诊病例和300多万例死亡。严重COVID-19疾病和死亡的几个危险因素,包括年龄、男性、肥胖,血管疾病在流感大流行的早期阶段就已经被确认。荟萃分析的证据表明,在已有精神障碍的患者中,严重或致命的COVID-19风险增加(OR 1.76,95%可信区间1.29–2.41)。有几个因素可能导致这种联系,包括躯体共病危险因素的高患病率,精神障碍患者获得适当的身体保健的机会减少,以及与精神障碍或治疗相关的免疫紊乱。

Livia JDe Picker等评估与任何既往精神障碍相关的COVID-19相关死亡、住院和重症监护病房(ICU)入院的特定风险,以及精神障碍的特定诊断类别,以及接触精神药理学类药物。

在这项系统回顾和荟萃分析中,在2020年1月1日至2021年3月5日期间搜索了科学网、Cochrane、PubMed和PsycINFO数据库,以获得报告精神障碍患者与对照组COVID-19结果的原始研究数据。排除了样本重叠的研究、未经同行评审的研究以及以英语、丹麦语、荷兰语、法语、德语、意大利语和葡萄牙语以外的语言编写的研究。

建立随机效应荟萃分析模型,以估计SARS-CoV-2感染后死亡率的原始优势比(OR)作为主要结果,住院和ICU入院作为次要结果。计算了可用数据的校正OR。使用评分法来评估证据的整体强度,并使用纽卡斯尔渥太华量表来评估研究质量。还进行了亚组分析和元回归分析,以评估基线COVID-19治疗设置、患者年龄、国家、大流行阶段、质量评估得分、样本量和混杂因素调整的影响。

841项研究被系统检索,其中33项研究被纳入系统综述,23项研究被纳入荟萃分析,包括1469731例COVID-19患者,其中43938人有精神障碍。样本包括130807名女性(占整个样本的8.9%)和130373例男性(8.8%)。

所有精神障碍死亡率的综合ORs森林图

按诊断类别分层的死亡率ORs森林图

所有精神疾病住院的综合ORs森林图

任何精神障碍的存在都与COVID-19死亡率的增加有关(OR 2.00[95%CI 1.58–2.54];I2=92·66%)。精神病患者(2·05[1·37–3·06];I2=80.81%,心境障碍(1.99[1.46-2.71];I2=68.32%,药物使用障碍(1.76[1.27-2.44];I2=47.90%,智力残疾和发育障碍(1.73[1.29-2.31];I2=90.15%)也观察到这种相关性,但不适用于焦虑症(1.07[0.73-1.56];I2=11.05%)。COVID-19死亡率与抗精神病药物(3·71[1·74-7·91];I2=90.31%,抗焦虑药(2.58[1.22-5.44];I2=96.42%,抗抑郁药(2.23[1.06-4.71];I2=95.45%)暴露有关。对于精神病性障碍、情绪障碍、抗精神病药和抗焦虑药,在调整了年龄、性别和其他混杂因素后,这种关联仍然显著。精神障碍与住院风险增加相关(2·24[1·70–2·94];I2=88.80%)。

ICU入院与死亡率无显著相关性。亚组分析和荟萃回归显示,基线COVID-19治疗(p=0.013)和国家(p<0.0001)与死亡率显著相关。其他协变量与死亡率无显著相关性。

在原始模型和调整模型中,既往存在的精神障碍,特别是精神病性和情绪障碍,以及暴露于抗精神病药和抗焦虑药与COVID-19死亡率相关。应考虑对所有该研究中确定的高危患者优先接种疫苗。此外,需要对出现COVID-19的精神障碍患者进行密切监测和适当的医院转诊,以抵消可能减少的治疗机会。

原文出处

Mental disorders and risk of COVID-19-related mortality, hospitalisation, and intensive care unit admission: a systematic review and meta-analysis

https://doi.org/10.1016/S2215-0366(21)00232-7

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    2021-11-18 howi
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    2021-07-20 goodbing

    顶刊就是不一样,质量很高,内容精彩!学到很多

    0

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