系统性皮质糖类固醇对风湿性关节炎患者主要心血管不良事件的时间和剂量依赖作用:基于人口的研究
Ho So1, Tsz On Lam1, Huan Meng1
1Department of Medicine & Therapeutics, The Chinese University, Hong Kong, Hong Kong.
Annals of the rheumatic diseases
|July 24, 2023
概括
在类风湿性关节炎 (RA) 患者中使用葡萄糖皮质类药物 (GC) 会增加心血管事件的风险,特别是在每日剂量为5mg或更高时. 在这项研究中,较低的GC剂量 (每天<5mg) 并没有显著提高心血管风险.
科学领域:
- 类风湿病学 类风湿病学
- 心脏病学 心脏病学
- 药理学 药理学是指药理学的学科.
背景情况:
- 类风湿性关节炎 (RA) 患者面临心血管疾病 (CVE) 风险升高的风险.
- 葡萄糖皮质醇 (GC) 的使用是已知的CVE风险在RA的贡献者,但一个明确的剂量反应值仍在争论中.
研究的目的:
- 调查葡萄糖皮质体 (GC) 剂量和持续时间对类风湿性关节炎 (RA) 患者重大心血管不良事件 (MACE) 风险的时间变化的影响.
- 为了确定GC使用的特定门是否会增加MACE的发生率.
主要方法:
- 从香港数据库 (2006-2018) 中对12233名RA患者进行了回顾性队列研究.
- 使用了时间变化的考克斯回归和逆概率治疗权重分析.
- 对人口统计,传统心血管风险因素,炎症标志物和抗风湿药物使用进行了调整.
主要成果:
- 在12233名RA患者中,共有860人 (7.0%) 在105826个患者年中经历了MACE.
- 每日普雷迪尼索隆剂量≥5毫克显著增加MACE风险 (HR 2.02-2.37),而剂量<5毫克没有.
- 每个额外的每日普雷迪尼索隆≥5毫克的月份都与MACE风险增加7%有关.
结论:
- 在RA患者中使用葡萄糖皮质类药物与MACE风险的持续时间和剂量相关的增加有关.
- 非常低剂量的每日普雷迪尼索隆 (<5毫克) 似乎不会给人带来显著的额外心血管风险.
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