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长期使用他汀类药物与胆囊疾病风险:基于人群的病例对照研究。

Long-term statin use and the risk of gallstone disease: A population-based case-control study.

机构信息

Department of Clinical Epidemiology, Aarhus University Hospital, Denmark.

出版信息

Am J Epidemiol. 2011 Jan 15;173(2):162-70. doi: 10.1093/aje/kwq361. Epub 2010 Nov 17.

Abstract

Most gallstones originate from cholesterol-supersaturated bile. Statins inhibit hepatic cholesterol biosynthesis and therefore may reduce the risk of gallstone disease. Population-based evidence, however, is sparse. Thus, the authors conducted a population-based case-control study using medical databases from northern Denmark (1.7 million inhabitants) to identify 32,494 cases of gallstones occurring between 1996 and 2008 and to identify age-, sex-, and county-matched population controls for each case. Cases and their matched controls who were exposed to lipid-lowering drugs were categorized as current users if their last prescription was redeemed ≤90 days before the case's diagnosis date; otherwise, they were categorized as former users. Conditional logistic regression was used to estimate adjusted odds ratios and 95% confidence intervals for gallstone disease in patients treated with lipid-lowering drugs. In current users, the adjusted odds ratios associating statin use with the occurrence of gallstone disease were 1.17 (95% confidence interval (CI): 1.06, 1.30) for those who had 1-4 prescriptions, 0.89 (95% CI: 0.80, 0.97) for those who had 5-19 prescriptions, and 0.76 (95% CI: 0.69, 0.84) for those who had ≥20 total prescriptions. In former users, the corresponding adjusted odds ratios were 1.24 (95% CI: 1.11, 1.39), 0.97 (95% CI: 0.86, 1.10), and 0.79 (95% CI: 0.64, 0.97), respectively. The use of other lipid-lowering drugs showed no similar association.

摘要

大多数胆结石源于胆固醇过饱和胆汁。他汀类药物抑制肝内胆固醇生物合成,因此可能降低胆石病的风险。然而,基于人群的证据很少。因此,作者使用丹麦北部的医疗数据库(170 万居民)进行了一项基于人群的病例对照研究,以确定 1996 年至 2008 年间发生的 32494 例胆结石病例,并为每个病例确定年龄、性别和郡匹配的人群对照。如果病例诊断日期前 90 天内最后一次处方被兑现,则将暴露于降脂药物的病例及其匹配对照者归类为当前使用者;否则,他们被归类为以前使用者。使用条件逻辑回归估计了降脂药物治疗患者患胆结石病的调整后比值比和 95%置信区间。在当前使用者中,与使用他汀类药物相关的胆结石病发生的调整后比值比为:处方 1-4 张者为 1.17(95%置信区间(CI):1.06,1.30);处方 5-19 张者为 0.89(95% CI:0.80,0.97);处方 20 张以上者为 0.76(95% CI:0.69,0.84)。在以前使用者中,相应的调整后比值比分别为 1.24(95% CI:1.11,1.39)、0.97(95% CI:0.86,1.10)和 0.79(95% CI:0.64,0.97)。其他降脂药物的使用则没有类似的关联。

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