Douglas Ian J, Cook Claire, Chakravarthy Usha, Hubbard Richard, Fletcher Astrid E, Smeeth Liam
Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom.
Ophthalmology. 2007 Jun;114(6):1164-9. doi: 10.1016/j.ophtha.2006.09.018.
To investigate the association between age-related macular degeneration (AMD) and exposure to antacids, antithyroids, thyroid hormones, and thiazide diuretics.
Matched case-control study.
Population-based participants were selected from the United Kingdom General Practice Research Database. A total of 18,007 people with diagnosed AMD were compared with 86 169 controls matched for age, gender, and general practice.
Conditional logistic regression was used to determine the association between exposure to each drug group of interest and a diagnosis of AMD, adjusting for relevant confounding variables.
The primary outcome was the odds ratio for the association between exposure to antacids, antithyroids, thyroid hormones, or thiazide diuretics and AMD. Secondary analyses were conducted to assess the effect of recent exposure to the drugs of interest, the total number of prescriptions received, and restricting the data set to participants with more than 2 years of observation time.
The crude odds ratios for association between any record of drug exposure and AMD were as follows: 1.34 (95% confidence interval [CI], 1.29-1.39) for antacids; 1.15 (95% CI, 0.92-1.44) for antithyroids; 1.34 (95% CI, 1.29-1.39) for thyroid hormones; and 1.13 (95% CI, 1.08-1.17) for thiazide diuretics. After adjusting for consultation rate, observation time, diabetes, heart failure, hyperlipidemia, cardiovascular drug use, atherosclerosis, hypertension, aspirin use, hormone replacement therapy use, body mass index, alcohol consumption, and smoking, the odds ratios reduced to: 1.06 (95% CI, 1.02-1.10) for antacids, 0.98 (95% CI, 0.78-1.24) for antithyroids, 0.99 (95% CI, 0.92-1.06) for thyroid hormones, and 0.98 (95% CI, 0.94-1.02) for thiazides. Secondary analyses were consistent with these findings for all 4 drug categories.
No association was detected between short- and medium-term use of antithyroids, thyroid hormones, and thiazide diuretics and the risk of AMD. Short- and medium-term use of antacids seems to be associated with a small increase in the risk of this disease. However, this increased risk is likely the result of residual confounding by smoking or uncontrolled confounding resulting from socioeconomic status. No conclusions could be drawn regarding longer-term use of each drug category.
研究年龄相关性黄斑变性（AMD）与使用抗酸剂、抗甲状腺药物、甲状腺激素和噻嗪类利尿剂之间的关联。
配对病例对照研究。
基于人群的参与者选自英国全科医学研究数据库。总共18007例确诊为AMD的患者与86169名年龄、性别和全科医疗相匹配的对照者进行比较。
采用条件逻辑回归来确定感兴趣的每种药物组的暴露与AMD诊断之间的关联，并对相关混杂变量进行调整。
主要结局是抗酸剂、抗甲状腺药物、甲状腺激素或噻嗪类利尿剂暴露与AMD之间关联的比值比。进行了二次分析以评估近期暴露于感兴趣药物的影响、收到的处方总数，并将数据集限制为观察时间超过2年的参与者。
药物暴露的任何记录与AMD之间关联的粗比值比如下：抗酸剂为1.34（95%置信区间[CI]，1.29 - 1.39）；抗甲状腺药物为1.15（95%CI，0.92 - 1.44）；甲状腺激素为1.34（95%CI，1.29 - 1.39）；噻嗪类利尿剂为1.13（95%CI，1.08 - 1.17）。在对会诊率、观察时间、糖尿病、心力衰竭、高脂血症、心血管药物使用、动脉粥样硬化、高血压、阿司匹林使用、激素替代疗法使用、体重指数、饮酒和吸烟进行调整后，比值比降至：抗酸剂为1.06（95%CI，1.02 - 1.10），抗甲状腺药物为0.98（95%CI，0.78 - 1.24），甲状腺激素为0.99（95%CI，0.92 - 1.06），噻嗪类为0.98（95%CI，0.94 - 1.02）。所有4类药物的二次分析结果与这些发现一致。
未检测到短期和中期使用抗甲状腺药物、甲状腺激素和噻嗪类利尿剂与AMD风险之间存在关联。短期和中期使用抗酸剂似乎与该疾病风险的小幅增加有关。然而，这种风险增加可能是吸烟导致的残余混杂或社会经济地位导致的未控制混杂的结果。关于每类药物的长期使用无法得出结论。
