Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
J Korean Med Sci. 2011 Jan;26(1):59-66. doi: 10.3346/jkms.2011.26.1.59. Epub 2010 Dec 22.
Angiotensin II type 1 receptor blocker (ARB), which is frequently prescribed in patients with glomerulonephritis (GN), is suggested to increase the risk of cancer. We registered 3,288 patients with renal biopsy and analyzed the relationship between the use of renin-angiotensin-aldosterone system (RAAS) blockade and the incidence of cancer or cancer mortality. After renal biopsy, cancer developed in 33 patients with an incidence rate of 1.0% (95% of CI for incidence: 0.7%-1.3%). There was no difference in the cancer incidence among the groups according to the use of angiotensin-converting enzyme inhibitors (ACEI) or ARB: 1.2% in the None (23/1960), 0.7% in the ARB-only (5/748), 0.4% in the ACEI-only (1/247), and 1.2% in the ACEI-ARB (4/333) (P = 0.487) groups. The cancer mortality was 2.1%, 0.4%, 0.0%, and 0.3% in None, ACEI-only, ARB-only, and ACEI-ARB group, respectively (P < 0.001). The risk of cancer mortality in patients with ARB was only 0.124 (0.034-0.445) compared to that of non-users of ARB by Cox's hazard proportional analysis. In conclusion, prescription of ACEI or ARB in patients with GN does not increase cancer incidence and recipients of ARB show rather lower rates of all-cause mortality and cancer mortality.
血管紧张素 II 型 1 型受体阻滞剂（ARB）常用于治疗肾小球肾炎（GN）患者，有研究提示其可能会增加癌症风险。我们登记了 3288 例接受肾活检的患者，并分析了肾素-血管紧张素-醛固酮系统（RAAS）阻滞剂的使用与癌症发生或癌症死亡率之间的关系。肾活检后，33 例患者发生癌症，发病率为 1.0%（95%CI：0.7%-1.3%）。根据 ACEI 或 ARB 的使用情况，各组癌症发病率无差异：无 ACEI/ARB 组（23/1960）为 1.2%，ARB 单药组（5/748）为 0.7%，ACEI 单药组（1/247）为 0.4%，ACEI/ARB 组（4/333）为 1.2%（P=0.487）。无 ACEI/ARB 组、ACEI 单药组、ARB 单药组和 ACEI/ARB 组的癌症死亡率分别为 2.1%、0.4%、0.0%和 0.3%（P<0.001）。Cox 比例风险分析显示，ARB 使用者的癌症死亡风险仅为 ARB 非使用者的 0.124（0.034-0.445）。总之，在 GN 患者中处方 ACEI 或 ARB 不会增加癌症发病率，ARB 使用者的全因死亡率和癌症死亡率较低。
