Division of Plastic Surgery, Centre Hospitalier de l'Universite de Montreal, Montreal, Canada.
Br J Clin Pharmacol. 2012 Aug;74(2):370-5. doi: 10.1111/j.1365-2125.2012.04191.x.
Several case reports have linked diclofenac, a non-steroidal anti-inflammatory drug (NSAID), with Clostridium difficile associated disease (CDAD). We assessed whether NSAID use in general, and diclofenac use in particular, is associated with an increased risk of CDAD.
We used the United Kingdom's General Practice Research Database (GPRD) to conduct a population-based case-control study. All cases of CDAD occurring between 1994 and 2005 were identified and were matched to 10 controls each. Conditional logistic regression was used to estimate the odds ratio of CDAD associated with current NSAID use, adjusting for covariates.
We identified 1360 CDAD cases and 13 072 controls. We found an increased risk of CDAD associated with diclofenac (adjusted odds ratio (RR) 1.35, 95% confidence interval (CI) 1.10, 1.67). We did not observe an increased risk of CDAD with use of any other NSAID. No dose-response for diclofenac exposure was found. When we analyzed only patients who were not hospitalized in the year before the index date, we found diclofenac to have a similar effect on CDAD risk (adjusted RR 1.43, 95% CI 1.11, 1.84).
Diclofenac use is associated with a modest increase in the risk of CDAD. In patients at risk of CDAD, other NSAIDs could be prescribed.
有几项病例报告将非甾体抗炎药（NSAID）双氯芬酸与难辨梭状芽孢杆菌相关性疾病（CDAD）联系起来。我们评估了一般使用 NSAID，特别是使用双氯芬酸是否与 CDAD 风险增加相关。
我们使用英国的一般实践研究数据库（GPRD）进行了一项基于人群的病例对照研究。确定了 1994 年至 2005 年期间发生的所有 CDAD 病例，并将每个病例与 10 个对照相匹配。使用条件逻辑回归来估计与当前 NSAID 使用相关的 CDAD 的优势比，同时调整协变量。
我们确定了 1360 例 CDAD 病例和 13072 例对照。我们发现与双氯芬酸相关的 CDAD 风险增加（调整后的优势比（RR）为 1.35，95%置信区间（CI）为 1.10，1.67）。我们没有观察到使用任何其他 NSAID 与 CDAD 风险增加相关。未发现双氯芬酸暴露的剂量反应关系。当我们仅分析索引日期前一年未住院的患者时，发现双氯芬酸对 CDAD 风险有类似的影响（调整后的 RR 为 1.43，95% CI 为 1.11，1.84）。
双氯芬酸的使用与 CDAD 风险的适度增加相关。对于有 CDAD 风险的患者，可以开其他 NSAID。
