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首页> 外文期刊>The journal of clinical psychiatry >Angiotensin Receptor Blockers and the Risk of Suicide: An Exercise in the Critical Examination of a Case-Control Study
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Angiotensin Receptor Blockers and the Risk of Suicide: An Exercise in the Critical Examination of a Case-Control Study

机译：血管紧张素受体阻滞剂和自杀的风险：对案例对照研究的关键检查的运动

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摘要

Angiotensin receptor blockers (ARBs), used in the treatment of hypertension, may modulate neurotransmission in the central nervous system. One previous very small case-control study had suggested that ARBs increase the odds of suicide. In a recent, large, population-based, nested case-control study conducted in Ontario, Canada, completed suicide was associated with significantly increased odds of an ARB prescription during the 100 days preceding the suicide; in this analysis, confounding by indication was reduced by comparing ARB exposure with angiotensin-converting enzyme inhibitor exposure. The results of this new study were widely disseminated in the scientific and mass media. However, at least some of the data presented in the study appeared implausible, and at least one important calculation was incorrect. Furthermore, important subgroup analyses were not conducted. These incongruities diminish the confidence of the reader in the data and in the analyses presented in the study. A generous conclusion is that, at best, ARB use is a marker of suicide risk that merits examination in studies that include a follow-up, in which absolute risks and dose-dependent and treatment duration-dependent effects can be examined. A parsimonious conclusion is that there is no association proven between ARB exposure and suicide.
机译：用于治疗高血压的血管紧张素受体阻滞剂（ARBs）可以调节中枢神经系统的神经传递。之前的一项非常小的病例对照研究表明，ARB会增加自杀的几率。在加拿大安大略省最近进行的一项大规模、以人群为基础的嵌套病例对照研究中，完全自杀与自杀前100天内服用ARB处方的几率显著增加有关；在这项分析中，通过比较ARB暴露与血管紧张素转换酶抑制剂暴露，减少了因适应症引起的混淆。这项新研究的结果在科学和大众媒体上广泛传播。然而，研究中至少有一些数据似乎不可信，至少有一个重要的计算是错误的。此外，没有进行重要的亚组分析。这些不一致降低了读者对研究数据和分析的信心。一个宽泛的结论是，ARB的使用充其量是自杀风险的标志，值得在包括随访在内的研究中进行检查，在这些研究中可以检查绝对风险、剂量依赖性和治疗持续时间依赖性效应。一个简单的结论是，ARB暴露与自杀之间没有关联。

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