Murray M D, Brater D C, Tierney W M, Hui S L, McDonald C J
Department of Pharmacy Practice, School of Pharmacy and Pharmacal Sciences, Purdue University, West Lafayette, Indiana.
Am J Med Sci. 1990 Apr;299(4):222-9. doi: 10.1097/00000441-199004000-00002.
The authors determined the incidence of ibuprofen-associated renal impairment and risk factors for its development in 1908 patients treated with ibuprofen using data from a computerized medical records system. Renal impairment occurred in 343 patients (18%). Multivariable analysis revealed six independent predictors of renal impairment: age, prior renal insufficiency, coronary artery disease, male gender, elevated systolic blood pressure, and diuretic use. They then tested the degree to which ibuprofen contributed to the development of renal impairment by evaluating a control group of 3933 acetaminophen recipients. Neither ibuprofen nor acetaminophen was among the independent predictors of risk when all patients were considered (adjusted odds ratio, 1.05; 95% Cl, 0.88-1.26). However, two subsets of at risk patients had an ibuprofen effect: patients greater than or equal to 65 years of age who received ibuprofen were at greater risk of renal impairment as compared to acetaminophen recipients (adjusted odds ratio, 1.34; 95% Cl, 1.05 to 1.72) as were patients with coronary artery disease (adjusted odds ratio, 2.54; 95% Cl, 1.38 to 4.68). Their results suggest that elderly patients and patients with coronary artery disease are at risk for ibuprofen-associated renal impairment and therefore should have their renal function monitored when ibuprofen and possibly other nonsteroidal anti-inflammatory drugs are prescribed.
作者利用计算机化医疗记录系统中的数据，确定了1908例使用布洛芬治疗的患者中布洛芬相关肾损伤的发生率及其发生的危险因素。343例患者（18%）出现了肾损伤。多变量分析揭示了肾损伤的六个独立预测因素：年龄、既往肾功能不全、冠状动脉疾病、男性、收缩压升高和使用利尿剂。然后，他们通过评估3933例对乙酰氨基酚接受者的对照组，来测试布洛芬对肾损伤发生的影响程度。当考虑所有患者时，布洛芬和对乙酰氨基酚均不是风险的独立预测因素（调整后的优势比为1.05；95%置信区间为0.88 - 1.26）。然而，有两个高危患者亚组出现了布洛芬效应：与对乙酰氨基酚接受者相比，年龄大于或等于65岁且接受布洛芬治疗的患者发生肾损伤的风险更高（调整后的优势比为1.34；95%置信区间为1.05至1.72），冠状动脉疾病患者也是如此（调整后的优势比为2.54；95%置信区间为1.38至4.68）。他们的结果表明，老年患者和冠状动脉疾病患者有发生布洛芬相关肾损伤的风险，因此，当开具布洛芬以及可能的其他非甾体抗炎药处方时，应监测他们的肾功能。
