van de Garde E M W, Souverein P C, van den Bosch J M M, Deneer V H M, Leufkens H G M
Dept of Pharmacoepidemiology and Pharmacotherapy, Utrecht Institute of Pharmaceutical Sciences (UIPS), Sorbonnelaan 16, 3583 CA Utrecht, The Netherlands.
Eur Respir J. 2006 Jun;27(6):1217-22. doi: 10.1183/09031936.06.00110005. Epub 2006 Feb 2.
The aim of the present study was to assess whether the use of angiotensin-converting enzyme (ACE) inhibitors is associated with a decreased risk of hospitalisation for community-acquired pneumonia (CAP) in a general, essentially white population. Data were obtained from the Dutch PHARMO Record Linkage System. Cases were defined as patients with a first hospital admission for CAP. For each case, up to four population controls were matched by age and sex. The study population comprised 1,108 patients with a first hospital admission for CAP and 3,817 matched controls. After adjusting for several confounders, ACE inhibitor use was not associated with a decreased incidence of pneumonia (adjusted odds ratio (OR) 1.12; 95% confidence interval (CI) 0.88-1.43). Additionally, no significant association was observed in patients with diabetes, respiratory diseases, heart failure, or patients with both of the last two conditions. Furthermore, adjustment of treatment effects on pneumonia risk using stratification on balancing score also showed no significant association between ACE inhibitor use and pneumonia risk within the different strata (overall adjusted OR 1.09; 95% CI 0.87-1.36). In contrast with previous findings in Asian populations, the current authors were not able to confirm the beneficial effect of angiotensin-converting enzyme inhibitors on pneumonia risk in a general, essentially white population.
本研究的目的是评估在一个主要为白人的普通人群中，使用血管紧张素转换酶（ACE）抑制剂是否与社区获得性肺炎（CAP）住院风险降低相关。数据来自荷兰PHARMO记录链接系统。病例定义为首次因CAP住院的患者。对于每个病例，按年龄和性别匹配多达四个对照人群。研究人群包括1108例首次因CAP住院的患者和3817例匹配的对照。在对多个混杂因素进行调整后，使用ACE抑制剂与肺炎发病率降低无关（调整后的优势比（OR）为1.12；95%置信区间（CI）为0.88 - 1.43）。此外，在糖尿病患者、呼吸系统疾病患者、心力衰竭患者或同时患有后两种疾病的患者中未观察到显著关联。此外，使用平衡评分分层对肺炎风险的治疗效果进行调整后，在不同分层中，使用ACE抑制剂与肺炎风险之间也未显示出显著关联（总体调整后的OR为1.09；95%CI为0.87 - 1.36）。与之前在亚洲人群中的研究结果相反，本研究作者无法证实血管紧张素转换酶抑制剂在一个主要为白人的普通人群中对肺炎风险的有益作用。
