长期使用阿司匹林与病进展的关联
Jun Ling Lu1, Prabin Shrestha1, Elani Streja2
1Division of Nephrology, University of Tennessee Health Science Center, Memphis, TN, United States.
Frontiers in medicine
|December 19, 2023
概括
在慢性病 (CKD) 患者中长期使用低剂量阿司匹林并没有降低死亡率或末期病 (ESKD) 风险. 然而,阿司匹林与更快的功能下降有关.
科学领域:
- 腎臟病學 (nephrology) 是一種醫學專業.
- 药理学 药理学是指药理学的学科.
- 流行病学 流行病学
背景情况:
- 慢性微炎症是慢性病 (CKD) 进展的关键驱动因素.
- 作为一种广泛使用的抗炎药物,阿司匹林 (ASA) 对CKD进展的长期影响尚不清楚.
- 了解低剂量ASA对CKD的影响对于患者管理至关重要.
研究的目的:
- 调查长期新开始低剂量阿司匹林使用与发生性CKD患者的临床结果之间的关联.
- 评估低剂量阿司匹林对所有原因死亡率,心血管/脑血管 (CV) 死亡率和末期病 (ESKD) 的影响.
- 评估低剂量阿司匹林对CKD进展速度的影响.
主要方法:
- 对美国退伍军人进行了一项全国性的队列研究,该研究涉及发生CKD的美国退伍军人.
- 倾向性得分匹配用于比较开始服用低剂量阿司匹林 (50-200毫克/天) 和从未服用阿司匹林的患者之间的结果.
- 包括死亡率,ESKD和估计的膜过率 (eGFR) 斜率在内的结果使用考克斯和竞争风险回归模型进行了分析.
主要成果:
- 在匹配的队列 (N=29,480) 中,随访时间中位数为4.9年,阿司匹林使用者表现出明显更高的功能下降的风险 (OR 1.30 [95%CI:1.18,1.44]).
- 低剂量阿司匹林的使用与所有原因死亡率 (HR 0.97 [95%CI: 0.94, 1.01]),心血管死亡率 (SHR 1.06 [95%CI: 0.99-1.14]),或ESKD (SHR 1.00 [95%CI: 0.88, 1.13]) 的风险降低无关.
- 在研究期间,很大一部分患者出现死亡率 (40.2%) 或达到ESKD (3.2%).
结论:
- 长期使用低剂量阿司匹林在发生CKD的患者中与加速的功能恶化有关.
- 在这个队列中,使用低剂量阿司匹林时没有观察到与死亡率或ESKD风险有关的显著益处.
- 这些发现表明,在CKD患者中,低剂量阿司匹林的潜在风险益处权衡,需要仔细考虑.
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