侵袭性牙科治疗后感染性内心炎的风险:单个案例研究
Tzu-Ting Chen1, Yi-Chun Yeh1,2, Kuo-Liong Chien1,3,4
1Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei (T.-T.C., Y.-C.Y., K.-L.C., M.-S.L., Y.-K.T.).
Circulation
|April 21, 2018
概括
侵袭性牙科治疗 (IDT) 不会增加感染性内心炎 (IE) 的风险. 这项研究没有发现显著的关联,这表明抗生素预防IE对台湾人口是不必要的.
科学领域:
- 心脏病学
- 传染性疾病
- 牙科医学
背景情况:
- 侵袭性牙科治疗 (IDT) 可能导致暂时的细菌血症,引发感染性内心炎 (IE) 风险的担忧.
- IDT与IE之间的联系存在争议,因为细菌可能进入血液并影响受损的心脏组织.
- 这项研究旨在澄清IDT与IE之间的关联.
研究的目的:
- 估计侵袭性牙科治疗 (IDT) 和传染性内心炎 (IE) 之间的关联.
- 确定IDT是否对IE的发展构成重大风险因素.
- 为牙科手术后预防IE提供抗生素预防指南.
主要方法:
- 使用台湾医疗保险数据库进行单个案例研究.
- 使用案例交叉和自我控制的案例系列设计来分析数据并隐式地调整时间不变的混因素.
- 应用条件后勤回归和条件波桑回归模型来评估在IDT后的各种延迟时的IE风险.
主要成果:
- 分析包括9120名IE患者 (病例交叉) 和8181名IE患者 (自我控制病例系列).
- 在IDT后4周内,IE的概率比率为1. 12 (95% CI,0. 94-1. 34).
- 自控病例系列在IDT后1至4周内发现IE的发病率比率为1. 14 (95% CI,1. 02-1. 26),没有观察到临床显著的风险增加.
结论:
- 在两项研究设计中,在IDT后的短时间内没有观察到临床显著的IE风险增加.
- 即使在高风险患者中,也没有发现IDT和IE之间的关联.
- 基于这些发现,对于台湾人口来说,预防IE的抗生素预防不必要.
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