异维 A 酸与心血管、脑血管和血栓栓塞性疾病的风险。

Isotretinoin and the risk of cardiovascular, cerebrovascular and thromboembolic disorders.

机构信息

Faculty of Pharmacy, University of Montreal, Montreal, Que., Canada.

出版信息

Dermatology. 2011;223(1):45-51. doi: 10.1159/000330326. Epub 2011 Aug 25.

DOI:10.1159/000330326

PMID:21865673

Abstract

BACKGROUND

Case reports suggest that isotretinoin use is associated with an increased risk of cardiovascular disorders; however, the clinical significance has not been determined.

OBJECTIVE

To determine whether isotretinoin increases the risk of cardiovascular outcomes.

METHODS

A case crossover study was performed among subjects who filled ≥1 isotretinoin prescription during 1984-2003. Cases were defined as those with a first-ever diagnosis or hospitalization for acute myocardial infarction (MI), stroke, phlebitis/thrombophlebitis, pulmonary embolism (PE) or thrombosis. Exposure to isotretinoin in a 5-month hazard period immediately prior to the index date (calendar date of the diagnosis or hospitalization for the study outcomes) was compared to a 5-month control period. Odds ratios (ORs) along with 95% confidence intervals (CIs) were estimated using conditional logistic regression.

RESULTS

Of 30,496 isotretinoin users identified, 872 (3%) cases met the inclusion criteria; 381 (43.7%) had a stroke, 268 (30.7%) phlebitis/thrombophlebitis, 133 (15.3%) MI, 61 (7.0%) PE and 29 (3.3%) thrombosis. When stratified according to type of outcome, ORs were 0.75 (95% CI: 0.38-1.47), 1.31 (95% CI: 0.64-2.69) and 2.00 (95% CI: 0.50-8.00) for stroke, phlebitis/thrombophlebitis and MI, respectively.

CONCLUSION

No statistically significant association was found between isotretinoin and cardiovascular, cerebrovascular and thromboembolic outcomes.

摘要

背景

病例报告表明，异维 A 酸的使用与心血管疾病风险增加有关；然而，其临床意义尚未确定。

目的

确定异维 A 酸是否会增加心血管结局的风险。

方法

在 1984 年至 2003 年期间，对至少使用过一次异维 A 酸处方的受试者进行了病例交叉研究。病例定义为首次诊断或因急性心肌梗死（MI）、中风、静脉炎/血栓性静脉炎、肺栓塞（PE）或血栓形成住院的患者。在指数日期（研究结局的诊断或住院的日历日期）之前的 5 个月危险期内暴露于异维 A 酸与 5 个月对照期进行比较。使用条件逻辑回归估计比值比（OR）及其 95%置信区间（CI）。

结果

在确定的 30496 名异维 A 酸使用者中，有 872 名（3%）符合纳入标准；381 名（43.7%）患有中风，268 名（30.7%）患有静脉炎/血栓性静脉炎，133 名（15.3%）患有 MI，61 名（7.0%）患有 PE，29 名（3.3%）患有血栓形成。根据结局类型分层时，中风、静脉炎/血栓性静脉炎和 MI 的 OR 分别为 0.75（95%CI：0.38-1.47）、1.31（95%CI：0.64-2.69）和 2.00（95%CI：0.50-8.00）。