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预防性药理疗法在尿病患者中的实际有效性:一项回顾性队列研究
John M Hollingsworth1, Mary K Oerline2, Ryan S Hsi3
1NorthShore University HealthSystem, Evanston, Illinois; Dow Division of Health Services Research, Department of Urology, Medical School, University of Michigan, Ann Arbor, Michigan.
概括
预防性药理疗法 (PPT) 用化尿剂治疗高性尿和性低尿液pH显著降低了老年人症状性结石事件. 与未接受治疗的患者相比,坚持患者的急诊室访问次数较少.
科学领域:
- 腎臟病學 (nephrology) 是一種醫學.
- 泌尿器科 泌尿器科 泌尿器科 泌尿器科
- 药理学 药理学是指药理学的学科.
背景情况:
- 预防性药理疗法 (PPT) 减少尿病复发的疗效数据通常依赖于具有不确定的临床意义的复合结果.
- 关于PPT对预防结石的有效性的现实数据是有限的,尽管已经建立了对 thiazide 利尿剂和治疗的试验证据.
研究的目的:
- 评估PPT使用是否会导致尿病的医疗保险入学者的症状性石头事件减少.
- 评估符合指导方针的PPT对结石的二次预防的实际有效性.
主要方法:
- 在医疗保险注册患者的回顾性队列研究中,他们患有尿病和特定的尿液异常 (高血症,低血症,低尿液pH值,高尿尿症).
- 根据患者遵守指导方针一致的PPT进行分类:坚持,不坚持或未接受治疗.
- 考克斯比例危险回归被用来分析PPT和症状性石头事件 (ED访问,住院或石头导向手术) 之间的关联.
主要成果:
- 在13,942名患者中,31.0%接受了PPT. 与没有治疗相比,坚持PPT的使用与高热症 (HR 0.736) 和低尿液pH (HR 0.804) 的症状性石头事件的风险明显较低.
- 事件的减少主要是由于加入PPT组的急诊室访问减少.
- 对于高性尿,预测2年ED访问概率为3.8% (坚持PPT) 与6.9% (不接受治疗);对于低尿液pH,它们为4.3% (坚持PPT) 与7.3% (不接受治疗).
结论:
- 在患有尿病的患者中,对超性尿素和性尿素的低尿液pH的治疗与较少的症状性石头事件有关.
- 这些发现支持在现实环境中使用和遵守PPT来预防复发性结石的二次预防.
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