吸入性皮质类固醇和黄金葡萄球菌隔离的风险在支气管切除症:一个基于登记的队列研究
Andrea Arlund Filipsen1, Karen Hougaard Frost1, Josefin Eklöf1
1Copenhagen Respiratory Research, Department of Medicine, Herlev and Gentofte Hospital, University of Copenhagen, 2900 Hellerup, Denmark.
高剂量的吸入性皮质类固醇 (ICS) 增加了非囊性纤维化支气管切开症 (BE) 患者中黄金葡萄球菌 (S. aureus) 隔离的风险. 由于这种关联,在BE患者中谨慎使用ICS.
科学领域:
- 肺部病理学 肺部病理学
- 传染性疾病 传染性疾病
- 药理学 药理学是指药理学的学科.
背景情况:
- 非囊性纤维化支气管炎 (BE) 是一种慢性呼吸道疾病,患病率和死亡率不断上升.
- 吸入性皮质类固醇 (ICS) 通常用于BE,尽管对肺功能益处的证据有限.
- 在BE中,ICS使用和黄金葡萄球菌 (S. aureus) 感染之间的潜在联系尚不清楚.
研究的目的:
- 调查在诊断前使用不同剂量的ICS与BE患者中S. aureus隔离风险之间的关联.
- 为了确定ICS剂量是否会影响这种人群中S. aureus分离的风险.
主要方法:
- 一项基于国家登记的丹麦BE患者队列研究,这些患者在2001-2018年间被诊断为BE患者.
- ICS暴露被分类为没有,低,中等和高剂量,根据诊断前365天赎回的处方.
- 使用因果特异的Cox比例危险回归和治疗加权的逆概率 (IPTW) 模型.
主要成果:
- 高剂量的ICS使用与S. aureus隔离的风险增加显著相关 (HR 3.81).
- 对于低或中等ICS剂量 (HR分别为1.22和1.24) 没有发现显著的关联.
- 使用IPTW的敏感性分析证实了这些发现.
结论:
- 高剂量的ICS治疗与非囊性纤维化支气管病症患者中S. aureus隔离的风险更高有关.
- 建议在处方ICS时谨慎使用,特别是在高剂量时,用于BE管理.
- 进一步的研究可能会探索这种关联背后的机制.
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