2型糖尿病患者使用非甾体抗炎药与慢性肾脏病风险：一项全国性纵向队列研究
Use of non-steroidal anti-inflammatory drugs and risk of chronic kidney disease in people with Type 2 diabetes mellitus, a nationwide longitudinal cohort study.
作者信息
Tsai H-J, Hsu Y-H, Huang Y-W, Chang Y-K, Liu J-S, Hsu C-C
机构信息
Division of Biostatistics and Bioinformatics, Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Taiwan; Department of Medical Genetics, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
出版信息
Diabet Med. 2015 Mar;32(3):382-90. doi: 10.1111/dme.12610. Epub 2014 Nov 11.
AIMS
To investigate the temporal relationship between non-steroidal anti-inflammatory drug use and the development of chronic kidney disease in people with Type 2 diabetes mellitus.
METHODS
We conducted a retrospective cohort study and followed up a population with Type 2 diabetes who were chronic kidney disease-free (n = 48,715) using national health insurance claims data in Taiwan. Exposure status to non-steroidal anti-inflammatory drugs in 2007 was measured. A total of 6406 subjects with incident chronic kidney disease were identified from the period 2008 to 2011. Multivariable proportional hazards models were applied to determine the temporal relationship between non-steroidal anti-inflammatory drug use and the development of chronic kidney disease.
RESULTS
We observed a significant temporal relationship between non-steroidal anti-inflammatory drug use and the development of chronic kidney disease in people with Type 2 diabetes. Compared with people not taking any non-steroidal anti-inflammatory drug in 2007, those who were taking such drugs for at least 90 days in 2007 had a higher risk of chronic kidney disease development (adjusted hazard ratio 1.37, 95% CI 1.26-1.49). In subgroup analyses, those people (irrespective of age, sex, various comorbidities and use of anti-hypertensive drugs, aspirin or acetaminophen) who were taking non-steroidal anti-inflammatory drugs for at least 90 days were more likely to develop chronic kidney disease than people who were not taking any non-steroidal anti-inflammatory drug.
CONCLUSIONS
The results suggest that there is a positive temporal relationship between non-steroidal anti-inflammatory drug use and increased risk of chronic kidney disease in people with Type 2 diabetes. The use of non-steroidal anti-inflammatory drugs should be based on clinical evaluations of benefits and risks, and should be prescribed with caution for people with Type 2 diabetes.
目的
探讨2型糖尿病患者使用非甾体抗炎药与慢性肾脏病发生之间的时间关系。
方法
我们进行了一项回顾性队列研究，利用台湾地区的国民健康保险理赔数据，对48715例无慢性肾脏病的2型糖尿病患者进行随访。测量了2007年非甾体抗炎药的暴露状态。2008年至2011年期间共识别出6406例新发慢性肾脏病患者。应用多变量比例风险模型来确定使用非甾体抗炎药与慢性肾脏病发生之间的时间关系。
结果
我们观察到2型糖尿病患者使用非甾体抗炎药与慢性肾脏病发生之间存在显著的时间关系。与2007年未服用任何非甾体抗炎药的患者相比，2007年服用此类药物至少90天的患者发生慢性肾脏病的风险更高（校正风险比1.37，95%置信区间1.26-1.49）。在亚组分析中，那些（无论年龄、性别、各种合并症以及是否使用抗高血压药物、阿司匹林或对乙酰氨基酚）服用非甾体抗炎药至少90天的患者比未服用任何非甾体抗炎药的患者更易发生慢性肾脏病。
结论
结果表明，2型糖尿病患者使用非甾体抗炎药与慢性肾脏病风险增加之间存在正向时间关系。非甾体抗炎药的使用应基于对获益和风险的临床评估，对2型糖尿病患者应谨慎开具此类药物。
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