Liu Xiao, Ma Jianyong, Huang Lin, Zhu Wengen, Yuan Ping, Wan Rong, Hong Kui
Cardiology Department, the Second Affiliated Hospital of Nanchang University Jiangxi Key Laboratory of Molecular Medicine, Jiangxi, China.
Medicine (Baltimore). 2017 Nov;96(44):e8273. doi: 10.1097/MD.0000000000008273.
The association between oral fluoroquinolones (FQs) usage and risk of severe arrhythmia-related events (ventricular arrhythmias and sudden cardiac death) remains controversial. Therefore we aimed to quantify this association and to evaluate the effects of FQs on adverse cardiovascular (CV) outcomes.
We retrieved data from the Cochrane Collaboration, PubMed, and China National Knowledge Infrastructure (CNKI) databases until August 2017. The studies that reported relative risk (RR) estimates with 95% confidence intervals (CIs) for the associations of interest were included. Data were extracted from the eligible articles, and we used a random effects model to calculate the effect estimates.
Of the 16 studies that were included, 7 studies included serious arrhythmias, 3 studies included CV death, and 11 studies included all-cause death. The pooled RRs of FQs use were: 2.29 (95% CI: 1.20-4.36, P = .01) for serious arrhythmias; 1.60 (95% CI: 1.17-2.20, P = .004) for CV death; and 1.02 (95% CI: 0.76-1.37, P = .92) for all-cause death. The RRs associated with serious arrhythmias were 6.27 for gatifloxacin, 4.20 for moxifloxacin, 1.73 for ciprofloxacin, and 1.41 for levofloxacin. Current FQs users showed an increased risk of serious arrhythmias in the subgroup analysis. Treatment with FQs is associated with an absolute risk increase of 160 additional sudden deaths or ventricular arrhythmias, and 43 additional CV deaths per 1 million treatment courses.
The use of FQs could increase the risk of serious arrhythmias and CV death but not increase or all-cause death. Moreover, moxifloxacin and levofloxacin showed a higher risk of serious arrhythmias.
口服氟喹诺酮类药物（FQs）的使用与严重心律失常相关事件（室性心律失常和心源性猝死）风险之间的关联仍存在争议。因此，我们旨在量化这种关联，并评估FQs对不良心血管（CV）结局的影响。
我们检索了Cochrane协作网、PubMed和中国知网（CNKI）数据库截至2017年8月的数据。纳入报告了感兴趣关联的相对风险（RR）估计值及95%置信区间（CIs）的研究。从符合条件的文章中提取数据，并使用随机效应模型计算效应估计值。
纳入的16项研究中，7项研究包括严重心律失常，3项研究包括CV死亡，11项研究包括全因死亡。FQs使用的合并RR分别为：严重心律失常为2.29（95%CI：1.20 - 4.36，P = 0.01）；CV死亡为1.60（95%CI：1.17 - 2.20，P = 0.004）；全因死亡为1.02（95%CI：0.76 - 1.37，P = 0.92）。与严重心律失常相关的RR，加替沙星为6.27，莫西沙星为4.20，环丙沙星为1.73，左氧氟沙星为1.41。在亚组分析中，当前使用FQs的患者严重心律失常风险增加。FQs治疗每100万个疗程会使额外的猝死或室性心律失常绝对风险增加160例，额外的CV死亡增加43例。
使用FQs可能会增加严重心律失常和CV死亡风险，但不会增加全因死亡风险。此外，莫西沙星和左氧氟沙星显示出更高的严重心律失常风险。
