一项基于人群的 2 年随访研究，探讨双膦酸盐与卒中风险的关系。
A population-based 2-year follow-up study on the relationship between bisphosphonates and the risk of stroke.
机构信息
Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
出版信息
Osteoporos Int. 2012 Oct;23(10):2551-7. doi: 10.1007/s00198-012-1894-0. Epub 2012 Jan 20.
UNLABELLED
This study aimed to explore the effect of bisphosphonate treatment on stroke using a large population cohort study. We found that the patients who received bisphosphonate therapy were less likely to suffer a stroke than comparison patients (hazard ratio (HR) = 0.79; 95% confidence interval (CI) = 0.66-0.99; p = 0.005) during a 2-year follow-up period.
INTRODUCTION
Animal models have suggested that bisphosphonates have a beneficial effect on the cardiovascular system. However, data on this topic in human subjects are still lacking. This study aimed to explore the protective effect of bisphosphonate treatment on stroke using a large population cohort study.
METHODS
We identified 2,148 patients who received bisphosphonate therapy for osteoporotic fractures. We randomly extracted 6,444 subjects with vertebral or hip fractures as a comparison group matched with the study group on age, sex, and year of index date. Each patient was individually tracked for 2 years to identify those who suffered a stroke. Stratified Cox proportional hazards regressions were performed to assess the effect of bisphosphonate treatment on the risk of stroke.
RESULTS
We found that 184 (8.6%) patients who received bisphosphonate therapy and 696 (10.8%) comparison patients suffered a stroke during the follow-up period. After adjusting for demographic variables and medical co-morbidities, stratified Cox proportional hazards regressions stratified by propensity score revealed that patients who received bisphosphonate therapy were less likely to suffer a stroke than comparison patients (HR = 0.79; 95% CI = 0.66-0.99). The adjusted HR for subarachnoid/intra-cerebral hemorrhage for patients who received bisphosphonate therapy was only 0.53 times (95% CI = 0.33-0.92) that of comparison patients, and the hazard of having an ischemic stroke during the 2-year follow-up period was 0.81 times that of comparison patients (95% CI = 0.65-0.96).
CONCLUSION
Patients who received bisphosphonate therapy were associated with a lower risk of stroke during a 2-year follow-up period.
目的
本研究旨在通过大样本队列研究探讨双膦酸盐治疗对卒中的影响。我们发现，与对照组相比，接受双膦酸盐治疗的患者在 2 年的随访期间发生卒中的风险较低（风险比（HR）=0.79；95%置信区间（CI）=0.66-0.99；p=0.005）。
背景
动物模型表明双膦酸盐对心血管系统有益。然而，关于人类的相关数据仍然缺乏。本研究旨在通过大样本队列研究探讨双膦酸盐治疗对卒中的保护作用。
方法
我们纳入了 2148 例因骨质疏松性骨折接受双膦酸盐治疗的患者。我们随机抽取了 6444 例因椎体或髋部骨折的患者作为对照组，与研究组在年龄、性别和索引日期方面相匹配。每位患者单独随访 2 年，以确定发生卒中的患者。采用分层 Cox 比例风险回归评估双膦酸盐治疗对卒中风险的影响。
结果
我们发现，在随访期间，接受双膦酸盐治疗的 184 例（8.6%）患者和对照组的 696 例（10.8%）患者发生了卒中。在调整人口统计学变量和合并症后，按倾向评分分层的分层 Cox 比例风险回归显示，接受双膦酸盐治疗的患者发生卒中的风险低于对照组（HR=0.79；95%CI=0.66-0.99）。接受双膦酸盐治疗的患者蛛网膜下腔/脑内出血的调整 HR 仅为对照组的 0.53 倍（95%CI=0.33-0.92），且在 2 年随访期间发生缺血性卒中的风险为对照组的 0.81 倍（95%CI=0.65-0.96）。
结论
在 2 年的随访期间，接受双膦酸盐治疗的患者卒中风险较低。
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