吸入性皮质类固醇对COPD-支气管切除重叠患者肺炎风险的影响:英国基于人口的病例对照研究
Andrew I Ritchie1, Aran Singayagam2, Sebastian Mitchell1
1National Heart and Lung Institute, Imperial College London, London, England.
Chest
|July 7, 2023
概括
吸入性皮质类固醇 (ICS) 不会增加COPD患者的肺炎风险,这些患者也患有支气管切除症. 支气管切除本身显著增加了肺炎的风险,但增加ICS并没有进一步提高这种风险.
科学领域:
- 肺部病理学 肺部病理学
- 临床医学 临床医学
- 流行病学 流行病学
背景情况:
- 吸入性皮质类固醇 (ICS) 经常被处方给COPD患者,包括那些同时患有支气管病的患者.
- 在COPD患者中,ICS使用与肺炎风险增加有关.
研究的目的:
- 调查COPD-支气管病重叠的患者中,与ICS相关的肺炎风险是否进一步增加.
- 评估支气管切除症对COPD患者的ICS使用和肺炎风险之间的关联的修饰作用.
主要方法:
- 一项使用COPD患者电子健康记录 (2004-2019) 的大型队列研究.
- 进行了嵌套病例控制分析,以评估肺炎住院风险.
- 进行了敏感性分析和子组分析,包括血中乙氨基酸细胞计数 (BEC).
主要成果:
- 支气管切除症显著增加了COPD患者肺炎的风险 (aHR=1.24).
- 只有在180天内使用时,ICS使用会增加肺炎的几率.
- 然而,支气管疏通减弱了ICS对肺炎风险的影响 (COPD-支气管疏通患者的AOR=1.01与无支气管疏通患者的1.27).
- 较低的血红蛋白细胞计数 (BEC ≤ 3 × 10 ^ 9 / L) 与COPD-支气管病重叠 (AOR=1.56) 的肺炎风险增加有关.
结论:
- 在患有慢性肺炎和支气管病变重叠的患者中,吸入性皮质类固醇的使用不会进一步增加已经存在的肺炎风险.
- 支气管切开症似乎改变了与ICS相关的风险,减少了它对肺炎发病率的影响.
- 血中乙素水平可能在调节肺炎风险方面发挥作用,在这个患者群体.
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