Basille Damien, Plouvier Nathalie, Trouve Charlotte, Duhaut Pierre, Andrejak Claire, Jounieaux Vincent
Respiratory and Intensive Care Unit, University Hospital Amiens, Amiens, 80054, France.
Recif Unit, University Hospital Amiens, Amiens, France.
Lung. 2017 Apr;195(2):201-208. doi: 10.1007/s00408-016-9973-1. Epub 2016 Dec 22.
Non-steroidal anti-inflammatory drugs (NSAIDs) are frequently prescribed or used as self-medication in cases of community-acquired pneumonia (CAP). Nevertheless, the consequences of such medication on the risk of pleuroparenchymal complications are not well known. The aim was to investigate whether exposure to NSAIDs prior to hospital admission among patients suffering from CAP is associated with the development of pleural complications or a lung abscess.
All consecutive non-immunocompromised patients with CAP and admitted to a university hospital were prospectively included (2-year period). The risk of pleuropulmonary complications was analyzed according to previous exposure to NSAIDs.
Of the 221 included patients, 40 (18.1%) had developed a pleuropulmonary complication. NSAIDs intake prior to admission was reported for 24 patients (10.9%) who were younger (50.6 ± 18.5 vs. 66.5 ± 16.4 years; p = 0.001), had less comorbidities (60 vs. 25.1%; p = 0.001), had a longer duration between the first symptoms of CAP and the start of an antibiotic therapy (6.1 ± 7.6 vs. 2.8 ± 3.8 days; p = 0.001), and who had a higher incidence of pleuropulmonary complications (33.3 vs. 16.2%; p = 0.048). In multivariate analyses, two factors were independently associated with the development of pleuroparenchymal complications: NSAIDs intake [Odds Ratio (OR) = 2.57 [1.02-6.64]; p = 0.049] and alcohol abuse (OR = 2.68 [1.27-5.69]; p = 0.01).
Our findings suggest that NSAIDs, often taken by young and healthy patients, may worsen the course of CAP with delayed therapy and a higher rate of pleuropulmonary complications.
非甾体抗炎药（NSAIDs）在社区获得性肺炎（CAP）病例中经常被处方使用或用于自我药疗。然而，此类药物对胸膜实质并发症风险的影响尚不清楚。本研究旨在调查CAP患者入院前使用NSAIDs是否与胸膜并发症或肺脓肿的发生有关。
前瞻性纳入一所大学医院收治的所有连续非免疫功能低下的CAP患者（为期2年）。根据之前是否使用过NSAIDs分析胸膜肺部并发症的风险。
在纳入的221例患者中，40例（18.1%）发生了胸膜肺部并发症。24例（10.9%）患者报告在入院前服用过NSAIDs，这些患者更年轻（50.6±18.5岁 vs. 66.5±16.4岁；p = 0.001），合并症较少（60% vs. 25.1%；p = 0.001），从CAP首发症状到开始抗生素治疗的时间间隔更长（6.1±7.6天 vs. 2.8±3.8天；p = 0.001），胸膜肺部并发症的发生率更高（33.3% vs. 16.2%；p = 0.048）。在多变量分析中，有两个因素与胸膜实质并发症的发生独立相关：服用NSAIDs[比值比（OR）= 2.57[1.02 - 6.64]；p = 0.049]和酗酒（OR = 2.68[1.27 - 5.69]；p = 0.01）。
我们的研究结果表明，年轻健康患者经常服用的NSAIDs可能会因治疗延迟和胸膜肺部并发症发生率较高而使CAP的病程恶化。
