吸入皮质类固醇治疗患者患带状疱疹的风险：一项队列研究。
Risk of herpes zoster in patients prescribed inhaled corticosteroids: a cohort study.
机构信息
Center for Clinical Epidemiology, Lady Davis Research Institute, Jewish General Hospital, Montreal, Canada.
出版信息
BMC Pulm Med. 2011 Dec 16;11:59. doi: 10.1186/1471-2466-11-59.
BACKGROUND
Little is known concerning risk factors for herpes zoster in the general population. We hypothesised that inhaled corticosteroids (ICS) are a risk factor for herpes zoster especially among users of inhibitors of cytochrome P450 enzymes involved in their metabolism.
METHODS
We identified a cohort of adult users of respiratory medications in the General Practice Research Database and carried out a nested case control analysis of inhaled corticosteroid use among 8900 new cases of herpes zoster and 88032 controls matching on age and calendar time.
RESULTS
The adjusted odds ratio for the relationship between current use of ICS and the occurrence of herpes zoster was 1.00 (95% confidence interval (CI), 0.94-1.07). There was no increase in risk of herpes zoster even at higher ICS doses; odds ratio 1.05 (95% CI, 0.96-1.14). Among subjects with concomitant prescriptions for an ICS and an inhibitor of cytochrome P450 3A4, the point estimate for the association between herpes zoster and the use of higher doses of inhaled corticosteroids was 1.23 (95% CI, 0.81-1.88).
CONCLUSIONS
The use of inhaled corticosteroids, even at high doses and in conjunction with inhibitors of their metabolism, was not a significant risk factor for the occurrence of herpes zoster in adults.
背景
关于普通人群中带状疱疹的风险因素知之甚少。我们假设吸入皮质类固醇（ICS）是带状疱疹的一个风险因素，尤其是在涉及到其代谢的细胞色素 P450 酶抑制剂的使用者中。
方法
我们在普通实践研究数据库中确定了一组使用呼吸药物的成年患者队列，并对 8900 例新发生的带状疱疹病例和 88032 名年龄和日历时间匹配的对照者进行了吸入皮质类固醇使用的嵌套病例对照分析。
结果
ICS 目前使用与带状疱疹发生之间的关系的调整比值比为 1.00（95%置信区间（CI），0.94-1.07）。即使在更高的 ICS 剂量下，也没有增加带状疱疹的风险；比值比为 1.05（95%CI，0.96-1.14）。在同时开有 ICS 和细胞色素 P450 3A4 抑制剂处方的患者中，与带状疱疹相关的较高剂量吸入皮质类固醇使用之间的关联的点估计值为 1.23（95%CI，0.81-1.88）。
结论
在成年人中，使用吸入皮质类固醇，即使在高剂量下并且与它们的代谢抑制剂一起使用，也不是带状疱疹发生的显著风险因素。
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