Brassard Paul, Bourgault Chantal, Brophy James, Kezouh Abbas, Suissa Samy
Department of Medicine, McGill University, Montreal, Canada.
Stroke. 2003 Sep;34(9):e163-6. doi: 10.1161/01.STR.0000085831.91042.BF. Epub 2003 Aug 7.
An increasing number of reports have linked infections to atherosclerosis and thrombosis. Thus, use of antibiotics may lower the risk of developing cerebrovascular disease. We investigated whether antibiotic use is associated with the risk of stroke in elderly individuals treated for hypertension.
A cohort of 29 937 elderly subjects initiating antihypertensive therapy between 1982 and 1995 was formed from the Quebec healthcare insurance database. A nested case-control design was used in which each subject hospitalized with a primary discharge diagnosis of stroke between 1987 and 1995 was matched on calendar time to 5 randomly selected controls from the cohort. Conditional logistic regression was used to estimate odds ratios of stroke after adjustment for predisposing factors.
We identified 1888 cases and 9440 controls. The overall adjusted odds ratio for current antibiotic use was 0.80 (95% confidence interval, 0.63 to 1.01), and that for recent use was 0.81 (95% confidence interval, 0.70 to 0.94). Penicillin was the only individual antibiotic class that showed a protective association across different time windows. No significant association was found between stroke risk and the use of fluoroquinolones, macrolides, tetracyclines, or cephalosporins.
Although no clear, consistent associations between overall antibiotic use and cerebrovascular disease could be found, an intriguing association between penicillin use and stroke should be explored further.
越来越多的报告将感染与动脉粥样硬化和血栓形成联系起来。因此，使用抗生素可能会降低发生脑血管疾病的风险。我们调查了在接受高血压治疗的老年个体中，使用抗生素是否与中风风险相关。
从魁北克医疗保险数据库中选取了一组在1982年至1995年间开始接受抗高血压治疗的29937名老年受试者。采用巢式病例对照设计，其中1987年至1995年间因首次出院诊断为中风而住院的每个受试者在日历时间上与从该队列中随机选择的5名对照进行匹配。使用条件逻辑回归来估计在对易感因素进行调整后中风的比值比。
我们确定了1888例病例和9440名对照。当前使用抗生素的总体调整后比值比为0.80（95%置信区间，0.63至1.01），近期使用抗生素的比值比为0.81（95%置信区间，0.70至0.94）。青霉素是唯一在不同时间窗口显示出保护性关联的单一抗生素类别。在中风风险与氟喹诺酮类、大环内酯类、四环素类或头孢菌素类药物的使用之间未发现显著关联。
虽然在总体抗生素使用与脑血管疾病之间未发现明确、一致的关联，但青霉素使用与中风之间的有趣关联应进一步探索。
