痛风中的慢性阿片类药物:来自退伍军人卫生管理局的一项匹配队列研究
Lindsay N Helget1,2, Bryant R England1,2, Punyasha Roul1,2
1Veterans Affairs Nebraska-Western Iowa Health Care System, Omaha, NE.
Arthritis care & research
|August 4, 2025
概括
患有痛风的人比没有这种情况的人更有可能接受慢性阿片类药物处方. 这种增加的风险与特定的人口和临床因素有关,强调需要更好的痛风管理策略.
科学领域:
- 类风湿病学 类风湿病学
- 疼痛管理 疼痛管理
- 公共卫生 公共卫生
背景情况:
- 痛风发作通常用阿片类药物治疗,但痛风患者对阿片类药物暴露的长期风险尚不清楚.
- 慢性阿片类药物使用是一个重大的公共卫生问题,需要对高风险患者群体进行研究.
研究的目的:
- 为了研究关于患有痛风的个体比没有痛风的个体更容易长期处方阿片类药物的假设.
- 在痛风患者群体中确定与慢性阿片类药物暴露相关的因素.
主要方法:
- 一个匹配的队列研究,利用国家退伍军人卫生管理局 (VA) 的数据.
- 多变量考克斯回归分析,以评估痛风和慢性阿片类药物接收之间的关联,通过验证的算法定义.
- 根据年龄,性别和VA入学年份,痛风病例与多达10个非痛风对照进行了匹配.
主要成果:
- 痛风患者的慢性阿片类药物接受率较高 (6.9%),与对照组相比 (3.8%),平均随访时间为4.52年.
- 在对共变量进行调整后,这种关联仍然存在 (调整后的危险比率[aHR] 1.30;95%信心区间[CI] 1.28, 1.32).
- 在痛风患者中,与慢性阿片类药物暴露增加相关的因素包括年龄较小,女性性别,少数种族/族裔,农村居住,肥胖,吸烟,更高的并发症,尿酸降低疗法和风湿病学咨询.
结论:
- 患有痛风的患者显著更有可能接受慢性阿片类药物处方,独立于其他风险因素.
- 某些子群体,包括代表性不足的人群,并发病率较高的人群,以及接受尿酸降低治疗或类风湿病咨询的患者,面临高风险.
- 需要进一步的研究来确定最佳的痛风管理是否可以减轻慢性阿片类药物暴露.
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