Wilson Hilary L, Schwartz Daniel M, Bhatt Hilarey R F, McCulloch Charles E, Duncan Jacque L
Department of Ophthalmology, UCSF School of Medicine, San Francisco, CA 94143, USA.
Am J Ophthalmol. 2004 Apr;137(4):615-24. doi: 10.1016/j.ajo.2003.10.025.
To investigate the relationship between statin and aspirin use and the risk of choroidal neovascularization (CNV) in patients with age-related macular degeneration (AMD).
Retrospective consecutive case series.
All patients 60 years and older with AMD who were seen between January 1, 1990, and March 1, 2003, at the San Francisco Veterans Affairs Hospital Eye Clinic with fundus photographs were included. Patients with other diagnoses predisposing to CNV or incomplete medical records were excluded. The main outcome measure was angiographically evident CNV. Diagnosis was based on review of fundus photographs and fluorescein angiograms in masked fashion; medical records were reviewed for variables possibly predisposing to CNV or statin use. For patients with CNV, age of onset was recorded; those without CNV were treated as censored. Age-related macular degeneration disease status and time of onset of CNV was compared between patients treated or not treated with statins for at least 6 months.
Of 326 patients with AMD, 104 had CNV, 204 had dry AMD, and 18 had geographic atrophy (GA). Of CNV subjects, 21 (20%) used statins, compared with 77 (38%) of dry AMD subjects without GA and 6 (33%) of controls with GA (hazard ratio = 0.51, 95% confidence interval (CI) = 0.31-0.86, P =.01). Aspirin use was also significantly associated with decreased rates of CNV; 62 CNV subjects (60%) used aspirin, compared with 154 (75%) dry AMD subjects without GA or 12 (67%) with GA (hazard ratio = 0.63, 95% CI = 0.40-0.98, P =.04).
Therapy with statins or aspirin is associated with decreased rates of CNV among AMD patients. Additional study with a prospective and/or randomized trial of statin and aspirin use in AMD patients is warranted.
研究他汀类药物和阿司匹林的使用与年龄相关性黄斑变性（AMD）患者脉络膜新生血管（CNV）风险之间的关系。
回顾性连续病例系列研究。
纳入1990年1月1日至2003年3月1日期间在旧金山退伍军人事务医院眼科诊所就诊、年龄在60岁及以上且有眼底照片的所有AMD患者。排除有其他易导致CNV的诊断或病历不完整的患者。主要观察指标为血管造影显示的CNV。诊断基于以盲法对眼底照片和荧光素血管造影进行审查；查阅病历以获取可能易导致CNV或他汀类药物使用的变量。对于患有CNV的患者，记录发病年龄；未患CNV的患者视为截尾。比较接受他汀类药物治疗至少6个月和未接受治疗的患者之间的年龄相关性黄斑变性疾病状态和CNV发病时间。
在326例AMD患者中，104例有CNV，204例为干性AMD，18例为地图状萎缩（GA）。在有CNV的患者中，21例（20%）使用他汀类药物，而在无GA的干性AMD患者中有77例（38%）使用，在有GA的对照患者中有6例（33%）使用（风险比=0.51，95%置信区间（CI）=0.31-0.86，P=0.01）。阿司匹林的使用也与CNV发生率降低显著相关；62例有CNV的患者（60%）使用阿司匹林，而在无GA的干性AMD患者中有154例（75%）使用，在有GA的患者中有12例（67%）使用（风险比=0.63，95%CI=0.40-0.98，P=0.04）。
他汀类药物或阿司匹林治疗与AMD患者中CNV发生率降低有关。有必要对AMD患者使用他汀类药物和阿司匹林进行前瞻性和/或随机试验的进一步研究。
