Idris Iskandar, Warren Graham, Donnelly Richard
Sherwood Forest Hospitals Foundation Trust, Nottinghamshire, England.
Arch Intern Med. 2012 Jul 9;172(13):1005-11. doi: 10.1001/archinternmed.2012.1938.
Findings of prior studies have been inconclusive about the ocular effects of thiazolidinediones on diabetic macular edema (DME). We evaluated, in patients with type 2 diabetes (T2D), the short-term and long-term risks of developing DME among users vs nonusers of thiazolidinediones.
A retrospective cohort study of 103,368 patients with T2D and no DME at baseline using The Health Improvement Network (THIN) database. Clinical, biochemical, and demographic information was obtained for the period January 1, 2000, through November 30, 2009.
At 1 year, the incidence of DME was 1.3% (n = 41) and 0.2% (n = 227) among thiazolidinedione users (n = 3227) and nonusers (n = 100,141), respectively (odds ratio [OR], 5.7 [95% CI, 4.1-7.9]). After Cox multiple regression analysis (adjusted for age; systolic blood pressure; levels of lipids and hemoglobin A(1c); and use of aspirin, fibrates, insulin, oral antidiabetic drugs, or renin-angiotensin system blockers), multiple imputation analysis to adjust for missing values, and propensity score analysis to exclude for any selection bias, thiazolidinedione use was associated with an increased risk of DME at 1-year follow-up (OR, 2.3 [95% CI, 1.5-3.6]) and 10-year follow-up (hazard ratio [HR], 2.3; [95% CI, 1.7-3.0]). The effect was similar for pioglitazone and rosiglitazone. Combination therapy with insulin plus a thiazolidinedione was associated with a higher risk of DME after propensity score adjustment (HR, 3.0 [95% CI, 1.5-5.9]), while aspirin use (HR, 0.6 [95% CI, 0.4-0.9]) and angiotensin-converting enzyme inhibitor use (HR, 0.4 [95% CI, 0.2-0.7]) were associated with a reduced risk of DME.
Among patients with T2D, treatment with a thiazolidinedione was associated with an increased risk of DME at 1-year and 10-year follow-up evaluations.
先前研究的结果对于噻唑烷二酮类药物对糖尿病性黄斑水肿（DME）的眼部影响尚无定论。我们评估了2型糖尿病（T2D）患者中，使用与未使用噻唑烷二酮类药物的人群发生DME的短期和长期风险。
使用健康改善网络（THIN）数据库，对103368例基线时无DME的T2D患者进行回顾性队列研究。获取了2000年1月1日至2009年11月30日期间的临床、生化和人口统计学信息。
1年时，噻唑烷二酮类药物使用者（n = 3227）中DME的发生率为1.3%（n = 41），未使用者（n = 100141）中为0.2%（n = 227）（优势比[OR]，5.7[95%CI，4.1 - 7.9]）。经过Cox多元回归分析（校正年龄、收缩压、血脂和糖化血红蛋白A1c水平，以及阿司匹林、贝特类药物、胰岛素、口服降糖药或肾素 - 血管紧张素系统阻滞剂的使用情况）、用于校正缺失值的多重填补分析以及用于排除任何选择偏倚的倾向评分分析后，在1年随访时，使用噻唑烷二酮类药物与DME风险增加相关（OR，2.3[95%CI，1.5 - 3.6]），在10年随访时也是如此（风险比[HR]，2.3；[95%CI，1.7 - 3.0]）。吡格列酮和罗格列酮的效果相似。胰岛素加噻唑烷二酮类药物的联合治疗在倾向评分调整后与DME风险较高相关（HR，3.0[95%CI，1.5 - 5.9]），而使用阿司匹林（HR，0.6[95%CI，0.4 - 0.9]）和血管紧张素转换酶抑制剂（HR，0.4[95%CI，0.2 - 0.7]）与DME风险降低相关。
在T2D患者中，在1年和10年随访评估时，使用噻唑烷二酮类药物治疗与DME风险增加相关。
