Chung Yi-Wei, Yang Yao-Hsu, Wu Cho-Kai, Yu Chih-Chieh, Juang Jyh-Ming Jimmy, Wang Yi-Chih, Tsai Chia-Ti, Lin Lian-Yu, Lai Ling-Ping, Hwang Juey-Jen, Chiang Fu-Tien, Chen Pau-Chung, Lin Jiunn-Lee
Division of Cardiology, Department of Internal Medicine, Chi Mei hospital, Taiwan.
Department for Traditional Chinese Medicine, Chang Gung Memorial Hospital Chia-Yi, Taiwan; Institute of Occupational Medicine and Industrial Hygiene, National Taiwan, University College of Public Health, Taipei, Taiwan.
Int J Cardiol. 2016 Jan 1;202:962-6. doi: 10.1016/j.ijcard.2015.05.167. Epub 2015 May 31.
Whether the spironolactone treatment remains effective for the prevention of atrial fibrillation (AF) in dialysis patients is unclear.
We used a database from the Registry for Catastrophic Illness from the National Health Research Institute. All dialysis patients aged 18 or older without history of AF before ESRD were incorporated. A total of 113,191 dialysis patients were enrolled in the study. The median follow-up time was 4.17 years. We collected information on prescribed drug dosage, number of days of treatment and the total number of pills dispensed from the outpatient pharmacy prescription database. All individuals in the study cohort with the first occurrence of AF were included as cases.
In spironolactone group, the incidence of developing new AF was significantly lower than that in the control group both before (0.8% vs. 3.3%, P=0.019) and after PS matching (1.2% vs. 3.0%, P=0.019). Before PS matching, Cox's proportional hazard regression analyses showed that spironolactone was associated with 60% reduction of new AF (HR=0.372 [0.200-0.692], P=0.002) and the protective effect is dose-responsive in accumulated dose, treatment duration and mean daily dose. After PS matching, the overall AF prevention effect remained significant (HR=0.400 [0.179-0.895], P=0.026) while the dose-response relationship became borderline significant. Subgroup analyses showed that the protective effect was more evident in some specific subgroup patients.
Our study showed that spironolactone therapy was associated with lower risk of developing AF in a dose-responsive manner in patients with dialysis. Further randomized study is needed to confirm this observation.
螺内酯治疗对预防透析患者房颤（AF）是否仍有效尚不清楚。
我们使用了来自国立卫生研究院重大疾病登记处的数据库。纳入所有18岁及以上在终末期肾病（ESRD）前无房颤病史的透析患者。共有113191名透析患者纳入本研究。中位随访时间为4.17年。我们从门诊药房处方数据库收集了规定药物剂量、治疗天数和配发药丸总数的信息。研究队列中首次发生房颤的所有个体被纳入病例组。
在螺内酯组中，新发房颤的发生率在倾向评分（PS）匹配前（0.8%对3.3%，P=0.019）和PS匹配后（1.2%对3.0%，P=0.019）均显著低于对照组。在PS匹配前，Cox比例风险回归分析显示螺内酯与新发房颤减少60%相关（风险比[HR]=0.372[0.200 - 0.692]，P=0.002），且在累积剂量、治疗持续时间和平均日剂量方面保护作用呈剂量反应关系。PS匹配后，总体房颤预防效果仍然显著（HR=0.400[0.179 - 0.895]，P=0.026），而剂量反应关系变得临界显著。亚组分析表明，保护作用在一些特定亚组患者中更明显。
我们的研究表明，螺内酯治疗与透析患者发生房颤的较低风险呈剂量反应关系。需要进一步的随机研究来证实这一观察结果。
