阿司匹林在 COPD 中的应用与呼吸系统并发症：COPD 亚人群及中间结局研究的倾向评分匹配分析。
Aspirin Use and Respiratory Morbidity in COPD: A Propensity Score-Matched Analysis in Subpopulations and Intermediate Outcome Measures in COPD Study.
机构信息
Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD.
Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY.
出版信息
Chest. 2019 Mar;155(3):519-527. doi: 10.1016/j.chest.2018.11.028. Epub 2018 Dec 26.
BACKGROUND
Aspirin use in COPD has been associated with reduced all-cause mortality in meta-regression analysis with few equivocal studies. However, the effect of aspirin on COPD morbidity is unknown.
METHODS
Self-reported daily aspirin use was obtained at baseline from SPIROMICS participants with COPD (FEV/FVC < 70%). Acute exacerbations of COPD (AECOPD) were prospectively ascertained through quarterly structured telephone questionnaires up to 3 years and categorized as moderate (symptoms treated with antibiotics or oral corticosteroids) or severe (requiring ED visit or hospitalization). Aspirin users were matched one-to-one with nonusers, based on propensity score. The association of aspirin use with total, moderate, and severe AECOPD was investigated using zero-inflated negative binomial models. Linear or logistic regression was used to investigate the association with baseline respiratory symptoms, quality of life, and exercise tolerance.
RESULTS
Among 1,698 participants, 45% reported daily aspirin use at baseline. Propensity score matching resulted in 503 participant pairs. Aspirin users had a lower incidence rate of total AECOPD (adjusted incidence rate ratio [IRR], 0.78; 95% CI, 0.65-0.94), with similar effect for moderate but not severe AECOPD (IRR, 0.86; 95% CI, 0.63-1.18). Aspirin use was associated with lower total St. George's Respiratory Questionnaire score (β, -2.2; 95% CI, -4.1 to -0.4), reduced odds of moderate-severe dyspnea (modified Medical Research Council questionnaire score ≥ 2; adjusted odds ratio, 0.69; 95% CI, 0.51-0.93), and COPD Assessment Test score (β, -1.1; 95% CI, -1.9 to -0.2) but not 6-min walk distance (β, 0.7 m; 95% CI, -14.3 to 15.6).
CONCLUSIONS
Daily aspirin use is associated with reduced rate of COPD exacerbations, less dyspnea, and better quality of life. Randomized clinical trials of aspirin use in COPD are warranted to account for unmeasured and residual confounding.
TRIAL REGISTRY
ClinicalTrials.gov; No.: NCT01969344; URL: www.clinicaltrials.gov.
背景
荟萃分析的元回归分析表明，在 COPD 中使用阿司匹林与全因死亡率降低相关，但关于阿司匹林对 COPD 发病率的影响尚不清楚。
方法
SPIROMICS 中 COPD 患者（FEV/FVC<70%）在基线时通过自我报告每日使用阿司匹林。通过每季度进行的结构化电话问卷前瞻性确定 COPD 急性加重（AECOPD），直至 3 年，并分为中度（用抗生素或口服皮质类固醇治疗症状）或重度（需要急诊就诊或住院治疗）。根据倾向评分，将阿司匹林使用者与非使用者一对一匹配。使用零膨胀负二项式模型研究阿司匹林使用与总 AECOPD、中度 AECOPD 和重度 AECOPD 的关系。线性或逻辑回归用于研究与基线呼吸症状、生活质量和运动耐量的关系。
结果
在 1698 名参与者中，45%的人在基线时报告每天使用阿司匹林。倾向评分匹配后，得到 503 对参与者。阿司匹林使用者总 AECOPD 的发生率较低（调整后的发病率比[IRR]，0.78；95%CI，0.65-0.94），中度但非重度 AECOPD 的效果相似（IRR，0.86；95%CI，0.63-1.18）。阿司匹林的使用与较低的总圣乔治呼吸问卷评分（β，-2.2；95%CI，-4.1 至-0.4）、较低的中重度呼吸困难几率（改良医学研究委员会问卷评分≥2；调整后的优势比，0.69；95%CI，0.51-0.93）和 COPD 评估测试评分（β，-1.1；95%CI，-1.9 至-0.2）相关，但与 6 分钟步行距离（β，0.7 m；95%CI，-14.3 至 15.6）无关。
结论
每日使用阿司匹林与降低 COPD 加重率、减少呼吸困难和改善生活质量有关。有必要进行阿司匹林治疗 COPD 的随机临床试验，以考虑未测量和残留的混杂因素。
试验注册
ClinicalTrials.gov；编号：NCT01969344；网址：www.clinicaltrials.gov。
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