BMJ:COPD患者用克拉霉素增加心血管事件
2013-06-15 青楚 医学论坛网
英国学者的一项研究显示,在慢性阻塞性肺疾病(COPD)急性加重期或社区获得性肺炎患者中应用克拉霉素与心血管事件风险增高有关。这些结果需要在其他数据库中进行验证。相关论文发表于BMJ杂志。 该研究包括2项前瞻性收集数据库数据的分析,一项为COPD数据库包括2009年~2011年之间,全英国范围内12家医院住院患者;另一项为爱丁堡肺炎队列研究包括2005年~2009年之间进入NHS 
英国学者的一项研究显示,在慢性阻塞性肺疾病(COPD)急性加重期或社区获得性肺炎患者中应用克拉霉素与心血管事件风险增高有关。这些结果需要在其他数据库中进行验证。相关论文发表于BMJ杂志。
该研究包括2项前瞻性收集数据库数据的分析,一项为COPD数据库包括2009年~2011年之间,全英国范围内12家医院住院患者;另一项为爱丁堡肺炎队列研究包括2005年~2009年之间进入NHS Lothian医院的患者。共纳入1343名住院的COPD急性加重期和1631名社区获得性肺炎的患者。主要结局测量指标为1年的心血管事件的风险比(被定义为因急性冠脉综合征,失代偿性心脏衰竭,严重心律失常,或心原性猝死而入院)和急性冠脉综合征(急性ST段抬高心肌梗死,非ST段抬高心肌梗死,和不稳定心绞痛)入院。次要结局为在1年时全因死亡和心血管死亡。
结果显示,一年期间COPD急性加重期患者队列中发生了268例心血管事件,社区获得性肺炎队列中发生了171例心血管事件。多变量调整后,COPD急性加重期应用克拉霉素与升高的心血管事件和急性冠脉综合征的风险相关——风险比分别为1.50(95%置信区间[CI],1.13~1.97)和1.67(1.04~2.68)。多变量调整后,社区获得性肺炎中应用克拉霉素与升高的心血管事件相关(风险比1.68,1.18~2.38),但是与急性冠脉综合征不相关(1.65,0.97~2.80)。克拉霉素的应用于心血管事件之间的关系在经过克拉霉素的倾向匹配后仍然存在。研究发现COPD急性加重期的克拉霉素应用和心血管性死亡之间(校正风险比1.52,1.02~2.26)有显著相关性,但与全因死亡(1.16,0.90~1.51)无关。而社区获得性肺炎中应用克拉霉素和全因死亡或心血管性死亡之间不相关。较长的克拉霉素应用持续期与更多的心血管事件有关。应用β-内酰胺类抗生素或强力霉素与COPD急性加重期患者中心血管事件增多不相关,表明了克拉霉素的特异性。
Abstract
Objective To study the association of clarithromycin with cardiovascular events in the setting of acute exacerbations of chronic obstructive pulmonary disease and community acquired pneumonia.
Design Analysis of two prospectively collected datasets.
Setting Chronic obstructive pulmonary disease dataset including patients admitted to one of 12 hospitals around the United Kingdom between 2009 and 2011; Edinburgh pneumonia study cohort including patients admitted to NHS Lothian Hospitals between 2005 and 2009.
Population 1343 patients admitted to hospital with acute exacerbations of chronic obstructive pulmonary disease and 1631 patients admitted with community acquired pneumonia.
Main outcome measures Hazard ratios for cardiovascular events at one year (defined as hospital admissions with acute coronary syndrome, decompensated cardiac failure, serious arrhythmia, or sudden cardiac death) and admissions for acute coronary syndrome (acute ST elevation myocardial infarction, non-ST elevation myocardial infarction, and unstable angina). Secondary outcomes were all cause and cardiovascular mortality at one year.
Results 268 cardiovascular events occurred in the acute exacerbations of chronic obstructive pulmonary disease cohort and 171 in the community acquired pneumonia cohort over one year. After multivariable adjustment, clarithromycin use in acute exacerbations of chronic obstructive pulmonary disease was associated with an increased risk of cardiovascular events and acute coronary syndrome—hazard ratios 1.50 (95% confidence interval 1.13 to 1.97) and 1.67 (1.04 to 2.68). After multivariable adjustment, clarithromycin use in community acquired pneumonia was associated with increased risk of cardiovascular events (hazard ratio 1.68, 1.18 to 2.38) but not acute coronary syndrome (1.65, 0.97 to 2.80). The association between clarithromycin use and cardiovascular events persisted after matching for the propensity to receive clarithromycin. A significant association was found between clarithromycin use and cardiovascular mortality (adjusted hazard ratio 1.52, 1.02 to 2.26) but not all cause mortality (1.16, 0.90 to 1.51) in acute exacerbations of chronic obstructive pulmonary disease. No association was found between clarithromycin use in community acquired pneumonia and all cause mortality or cardiovascular mortality. Longer durations of clarithromycin use were associated with more cardiovascular events. Use of β lactam antibiotics or doxycycline was not associated with increased cardiovascular events in patients with acute exacerbations of chronic obstructive pulmonary disease, suggesting an effect specific to clarithromycin.
Conclusions The use of clarithromycin in the setting of acute exacerbations of chronic obstructive pulmonary disease or community acquired pneumonia may be associated with increased cardiovascular events. These findings require confirmation in other datasets.
作者:青楚
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