Chen Stephanie P, Singh Kuldev, Lin Shan C
Department of Ophthalmology, Stanford University School of Medicine, Stanford, California, United States of America.
Department of Ophthalmology, University of California San Francisco, San Francisco, California, United States of America.
PLoS One. 2017 Aug 17;12(8):e0183388. doi: 10.1371/journal.pone.0183388. eCollection 2017.
While decreased ocular blood flow is thought to be a possible contributor to glaucoma pathogenesis, it is unclear what role systemic phosphodiesterase inhibitors (PDEi) play. We performed a cross-sectional study of a nationally representative sample of the U.S. population to investigate the relationship between the most commonly used PDEi, sildenafil and theophylline, and self-reported glaucoma.
We used the National Health and Nutrition Examination Survey 2005-2008 cycles for this observational study. 7,042 participants, aged 40 years and over, responded to a survey item on glaucoma status and were included in the analysis. Multivariable logistic regression models were constructed to evaluate the association between at least 1 year of self-reported PDEi use and prevalent glaucoma. Regressions were adjusted for potential confounding variables, including demographics, socioeconomic status, and general health conditions, and accounted for the complex design of the survey. Sample weights were constructed and used to ensure the generalizability of results.
482 respondents self-reported a diagnosis of glaucoma, of which 11 used sildenafil and 20 used theophylline for at least 1 year. Covariates significantly associated with higher odds of glaucoma prevalence in univariable analyses included older age, black race, former smoking status, diabetes, hyperlipidemia, myocardial infarction, and stroke. Conversely, higher education and income were significantly associated with lower odds of glaucoma prevalence. In regression analyses adjusted for demographic and socioeconomic variables, sildenafil (OR = 4.90, CI: 1.24-19.27, p = 0.025) and theophylline (OR = 3.15, CI: 1.46-6.80, p = 0.005) were significantly associated with higher odds of self-reported glaucoma. These associations held after further adjustment with general health behaviors and conditions for both sildenafil and theophylline.
Use of sildenafil and theophylline for one or more years was associated with greater prevalence of self-reported glaucoma, a finding which requires further prospective study to assess causality and possible mechanisms of action.
虽然眼血流量减少被认为可能是青光眼发病机制的一个因素，但尚不清楚全身性磷酸二酯酶抑制剂（PDEi）起何种作用。我们对美国人口的一个具有全国代表性的样本进行了一项横断面研究，以调查最常用的PDEi西地那非和茶碱与自我报告的青光眼之间的关系。
我们使用2005 - 2008年周期的美国国家健康和营养检查调查进行这项观察性研究。7042名年龄在40岁及以上的参与者回答了关于青光眼状况的调查项目，并被纳入分析。构建多变量逻辑回归模型以评估自我报告使用PDEi至少1年与青光眼患病率之间的关联。回归分析针对潜在的混杂变量进行了调整，包括人口统计学、社会经济地位和一般健康状况，并考虑了调查的复杂设计。构建并使用样本权重以确保结果的可推广性。
482名受访者自我报告诊断为青光眼，其中11人使用西地那非，20人使用茶碱至少1年。在单变量分析中与青光眼患病率较高几率显著相关的协变量包括年龄较大、黑人种族、既往吸烟状况、糖尿病、高脂血症、心肌梗死和中风。相反，较高的教育程度和收入与青光眼患病率较低几率显著相关。在针对人口统计学和社会经济变量进行调整的回归分析中，西地那非（OR = 4.90，CI：1.24 - 19.27，p = 0.025）和茶碱（OR = 3.15，CI：1.46 - 6.80，p = 0.005）与自我报告的青光眼较高几率显著相关。在对西地那非和茶碱的一般健康行为和状况进行进一步调整后，这些关联仍然成立。
使用西地那非和茶碱一年或更长时间与自我报告的青光眼患病率较高相关，这一发现需要进一步的前瞻性研究来评估因果关系和可能的作用机制。
