Lin Shu-Man, Yang Shih-Hsien, Cheng Hung-Yu, Liang Chung-Chao, Huang Huei-Kai
Department of Physical Medicine and Rehabilitation, Buddhist Tzu Chi General Hospital, Hualien, Taiwan.
School of Medicine, Tzu Chi University, Hualien, Taiwan.
BMJ Open. 2017 Sep 27;7(9):e016992. doi: 10.1136/bmjopen-2017-016992.
This study aimed to investigate the association between thiazide use and the risk of hip fracture after stroke.
A population-based, propensity-matched cohort study was conducted on the basis of Taiwan's National Health Insurance Research Database.
Patients with newly diagnosed ischaemic stroke between 2000 and 2011 were included. After propensity score matching, 7470 patients were included, of whom 3735 received thiazides and 3735 did not.
HRs for developing hip fractures within 2 years after stroke were calculated using Cox proportional hazards regression model with adjustments for sociodemographic and coexisting medical conditions.
Overall, patients using thiazides after stroke had a lower risk of hip fracture than those not using thiazides (8.5 vs 13.9 per 1000 person-years, adjusted HR=0.64, 95% CI 0.46 to 0.89, p=0.007). Further sensitivity analysis based on the duration of thiazide use revealed that the risk of hip fracture tended to decrease as the duration of exposure of thiazides increased. However, the effect was significant only in patients with long-term use of thiazides (using thiazides for >365 days within 2 years after stroke), with a 59% reduction in the risk of hip fracture when compared with patients not using thiazide (adjusted HR=0.41, 95% CI 0.22 to 0.79, p=0.008).
The long-term use of thiazides is associated with a decreased risk of hip fracture after stroke.
本研究旨在调查噻嗪类药物的使用与中风后髋部骨折风险之间的关联。
基于台湾国民健康保险研究数据库进行了一项基于人群的倾向匹配队列研究。
纳入2000年至2011年间新诊断为缺血性中风的患者。经过倾向得分匹配后，纳入7470名患者，其中3735名接受了噻嗪类药物治疗，3735名未接受。
使用Cox比例风险回归模型计算中风后2年内发生髋部骨折的风险比（HRs），并对社会人口统计学和并存的医疗状况进行调整。
总体而言，中风后使用噻嗪类药物的患者发生髋部骨折的风险低于未使用噻嗪类药物的患者（每1000人年分别为8.5例和13.9例，调整后的HR = 0.64，95%可信区间为0.46至0.89，p = 0.007）。基于噻嗪类药物使用持续时间的进一步敏感性分析表明，髋部骨折风险倾向于随着噻嗪类药物暴露持续时间的增加而降低。然而，这种效应仅在长期使用噻嗪类药物的患者中显著（中风后2年内使用噻嗪类药物>365天），与未使用噻嗪类药物的患者相比，髋部骨折风险降低了59%（调整后的HR = 0.41，95%可信区间为0.22至0.79，p = 0.008）。
噻嗪类药物的长期使用与中风后髋部骨折风险降低有关。
