他汀类药物暴露与巨细胞动脉炎的发生或更好的预后有关吗？一项基于法国人群的研究结果。

Is statin exposure associated with occurrence or better outcome in giant cell arteritis? Results from a French population-based study.

作者信息

Pugnet Grégory, Sailler Laurent, Bourrel Robert, Montastruc Jean-Louis, Lapeyre-Mestre Maryse

机构信息

From the Faculté de Médecine, and the Laboratoire de Pharmacologie Médicale et Clinique, Université de Toulouse III; INSERM, UMR1027; Service de Médecine Interne, and the Service de Pharmacologie Clinique, Centre Hospitalier Universitaire (CHU) Toulouse; Caisse Nationale d'Assurance Maladie des Travailleurs Salariés, Service Médical Midi-Pyrénées, Toulouse, France.G. Pugnet, MD; L. Sailler, MD, PhD, Université de Toulouse III, INSERM, UMR1027, Service de Médecine Interne, CHU Toulouse; R. Bourrel, MD, Caisse Nationale d'Assurance Maladie des Travailleurs Salariés, Service Médical Midi-Pyrénées; J-L. Montastruc, MD, PhD; M. Lapeyre-Mestre, MD, PhD, Université de Toulouse III, INSERM, UMR1027, Laboratoire de Pharmacologie Médicale et Clinique, Université de Toulouse III, Service de Pharmacologie Clinique, CHU Toulouse.

出版信息

J Rheumatol. 2015 Feb;42(2):316-22. doi: 10.3899/jrheum.140906. Epub 2014 Dec 15.

DOI:10.3899/jrheum.140906

PMID:25512477

Abstract

OBJECTIVE

To investigate the potential association between statin use and giant cell arteritis (GCA) course.

METHODS

Using the French National Health Insurance system, we included patients with incident GCA from the Midi-Pyrenees region, southern France, from January 2005 to December 2008 and randomly selected 6 controls matched by age, sex, and date of diagnosis. Statin exposure was compared between patients with GCA and their controls before GCA occurrence with a logistic regression. Influence of statin exposure on prednisone requirements during GCA course was explored with a Cox model, considering statin exposure as a time-varying variable.

RESULTS

The cohort included 103 patients (80 women, mean age 74.8 ± 9 yrs, mean followup 48.9 ± 14.8 mos), compared to 606 controls. Statin exposure (27.2% of patients with GCA and 23.4% of controls) was not associated with GCA occurrence (adjusted OR 1.2, 95% CI 0.76-1.96; p = 0.41). Diabetes mellitus was significantly associated to GCA occurrence (adjusted OR 0.38, 95% CI 0.11-0.72; p = 0.008). After diagnosis, exposure to statins up to 20 months was associated with maintenance while taking low prednisone doses (p = 0.01).

CONCLUSION

Statin exposure was not associated with GCA occurrence in the general population. However, exposure to statins up to 20 months may favor a quicker corticosteroid tapering. Based on those results, statin effect on GCA course should not be definitively ruled out.

摘要

目的

探讨他汀类药物使用与巨细胞动脉炎（GCA）病程之间的潜在关联。

方法

利用法国国家医疗保险系统，我们纳入了2005年1月至2008年12月来自法国南部米迪 - 比利牛斯地区的初发GCA患者，并随机选取6名年龄、性别和诊断日期匹配的对照。采用逻辑回归比较GCA患者及其对照在GCA发病前的他汀类药物暴露情况。使用Cox模型探讨他汀类药物暴露对GCA病程中泼尼松需求的影响，将他汀类药物暴露视为一个随时间变化的变量。

结果

该队列包括103例患者（80名女性，平均年龄74.8±9岁，平均随访48.9±14.8个月），对照为606名。他汀类药物暴露（GCA患者中为27.2%，对照中为23.4%）与GCA发病无关（校正比值比1.2，95%置信区间0.76 - 1.96；p = 0.41）。糖尿病与GCA发病显著相关（校正比值比0.38，95%置信区间0.11 - 0.72；p = 0.008）。诊断后，长达20个月的他汀类药物暴露与低剂量泼尼松维持治疗相关（p = 0.01）。