吸入和口服皮质类固醇的使用与白内障的长期风险

Use of inhaled and oral corticosteroids and the long-term risk of cataract.

作者信息

Wang Jie Jin, Rochtchina Elena, Tan Ava Grace, Cumming Robert G, Leeder Stephen R, Mitchell Paul

机构信息

Centre for Vision Research, Department of Ophthalmology, University of Sydney, Sydney, Australia.

出版信息

Ophthalmology. 2009 Apr;116(4):652-7. doi: 10.1016/j.ophtha.2008.12.001. Epub 2009 Feb 25.

DOI:10.1016/j.ophtha.2008.12.001

PMID:19243828

Abstract

OBJECTIVE

Longitudinal associations between inhaled and oral corticosteroid use and 10-year incident cataract were examined.

DESIGN

Population-based cohort study.

PARTICIPANTS

The Blue Mountains Eye Study examined 3654 Australians aged 49 years or older (1992-1994); 2335 were re-examined after 5 years and 1952 were re-examined after 10 years (75.1%, 75.6% of survivors, respectively).

METHODS

Questionnaires were used to assess inhaled and oral corticosteroid use at baseline. Past users were participants who had used these medications for at least 1 month in the past but were not using them at baseline. Current users were those who were using these medications at baseline and had been doing so for at least 1 month. Ever users combined past and current users.

MAIN OUTCOME MEASURES

Lens photographs were obtained at each examination and graded for nuclear, cortical, and posterior subcapsular (PSC) cataracts following the Wisconsin Cataract Grading System. Participants without a specific subtype of cataract in either eye at baseline were considered to be at risk of that type of cataract developing over the 10-year follow-up. Incidence of each cataract subtype in this report refers to person-specific, first-eye incidence.

RESULTS

At baseline, 103 participants were current and 120 past users of inhaled corticosteroids, and 31 were current and 147 were past users of oral corticosteroids. Current users had a greater risk of developing PSC cataract after adjustment for age and gender (inhaled: odds ratio [OR] 2.50, 95% confidence interval [CI] 1.33-4.69; oral: OR 4.11; 95% CI 1.67-10.08) and nuclear cataract (inhaled: OR 2.04, 95% CI 1.21-3.43; oral: OR 3.45, 95% CI 1.26-9.43) but not cortical cataract. Interaction between inhaled and oral corticosteroid use was significant for PSC (P = 0.01) and nuclear (P = 0.02) cataract incidence. In subgroup analyses, only individuals who used both inhaled and oral steroids were at increased risk of PSC cataract (after adjusting for age, sex, smoking, hypertension, diabetes, and education levels; OR 4.76, 95% CI 2.59-8.74), comparing ever users of both with users of neither.

CONCLUSIONS

High long-term risks of PSC and nuclear cataract development were found for users of combined inhaled and oral corticosteroids.

摘要

目的

研究吸入性和口服糖皮质激素的使用与10年新发白内障之间的纵向关联。

设计

基于人群的队列研究。

参与者

蓝山眼研究对3654名49岁及以上的澳大利亚人进行了检查（1992 - 1994年）；5年后对2335人进行了复查，10年后对1952人进行了复查（分别占幸存者的75.1%、75.6%）。

方法

通过问卷评估基线时吸入性和口服糖皮质激素的使用情况。既往使用者是过去曾使用这些药物至少1个月但在基线时未使用的参与者。当前使用者是在基线时正在使用这些药物且已使用至少1个月的人。曾经使用者包括既往使用者和当前使用者。

主要观察指标

每次检查时获取晶状体照片，并按照威斯康星白内障分级系统对核性、皮质性和后囊下（PSC）白内障进行分级。基线时双眼均无特定类型白内障的参与者被认为在10年随访期间有发生该类型白内障的风险。本报告中每种白内障亚型的发病率指个体特异性的单眼发病率。

结果

基线时，103名参与者为吸入性糖皮质激素的当前使用者，120名为既往使用者；31名是口服糖皮质激素的当前使用者，147名是既往使用者。在调整年龄和性别后，当前使用者发生PSC白内障的风险更高（吸入性：比值比[OR] 2.50，95%置信区间[CI] 1.33 - 4.69；口服：OR 4.11；95% CI 1.67 - 10.08）以及核性白内障（吸入性：OR 2.04，95% CI 1.21 - 3.43；口服：OR 3.45，95% CI 1.26 - 9.43），但皮质性白内障并非如此。吸入性和口服糖皮质激素使用之间的相互作用对PSC（P = 0.01）和核性（P = 0.02）白内障发病率有显著影响。在亚组分析中，仅同时使用吸入性和口服糖皮质激素的个体发生PSC白内障的风险增加（在调整年龄、性别、吸烟、高血压、糖尿病和教育水平后；OR 4.76，95% CI 2.59 - 8.74），将同时使用两种药物的曾经使用者与两种药物都未使用者进行比较。