Department of Internal Medicine, University of Missouri-Kansas City, Kansas City, MO 64108, USA.
Division of Cardiovascular Diseases, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA 52242, USA.
Int J Cardiol. 2019 Jan 1;274:299-302. doi: 10.1016/j.ijcard.2018.09.067. Epub 2018 Sep 21.
To investigate the association between fluoroquinolones use and development of aortopathy.
A systematic review and meta-analysis was conducted following PRISMA and MOOSE guidelines for reporting systematic reviews of observational studies. Multiple databases were searched and two authors independently screened studies for eligibility. Newcastle Ottawa scale was used to assessed the quality of included studies. Primary outcome of interest was development of aortic aneurysm or dissection among fluoroquinolones users in comparison to non-users. An inverse variance model meta-analysis was used to pool odds ratio or hazards ratio from included studies to calculate the overall effect estimate. Pre specified subgroups analyses were also conducted to explore sources of heterogeneity.
Three observational studies that enrolled 941,639 subjects met the inclusion criteria and were included in the final analysis. All studies were of a good methodological quality. Current use of fluoroquinolones, defined as within 60 days from development of the primary outcome, was associated with significantly elevated risk of developing aortic aneurysm and/or dissection in comparison to controls, (OR = 2.04; 95% CI [1.67, 2.48]). There was only a mild degree of between study heterogeneity, I = 33%. The association remains robust among all subgroups analyses.
Our findings indicate that current fluoroquinolone use was significantly associated with increased risk of aortic aneurysm and dissection. Health care providers need to be aware of this serious association and use fluoroquinolones judiciously in order to minimize the risk of the serious sequela of aortopathy.
探讨氟喹诺酮类药物使用与主动脉病变发展之间的关系。
按照 PRISMA 和 MOOSE 指南报告观察性研究的系统评价，进行系统评价和荟萃分析。检索多个数据库，由两名作者独立筛选研究的合格性。使用纽卡斯尔-渥太华量表评估纳入研究的质量。主要观察结果是氟喹诺酮类药物使用者与非使用者相比，是否发生主动脉瘤或夹层。采用逆方差模型荟萃分析汇总纳入研究的比值比或风险比，以计算总体效应估计。还进行了预先指定的亚组分析，以探索异质性的来源。
纳入了 3 项观察性研究，共纳入了 941639 名受试者，符合最终分析的纳入标准。所有研究的方法学质量都很好。氟喹诺酮类药物的当前使用（定义为在主要结局发生的 60 天内使用）与对照组相比，显著增加了发生主动脉瘤和/或夹层的风险（OR=2.04；95%CI[1.67,2.48]）。研究之间的异质性程度只有轻度，I²=33%。所有亚组分析的结果均稳健。
我们的研究结果表明，当前氟喹诺酮类药物的使用与主动脉瘤和夹层的风险增加显著相关。医疗保健提供者需要意识到这种严重的关联，并谨慎使用氟喹诺酮类药物，以最大程度地降低主动脉病变严重后果的风险。
