种族关联与新生儿阿片类戒断综合征的药物治疗。
Racial association and pharmacotherapy in neonatal opioid withdrawal syndrome.
机构信息
University of Maryland Medical Center, Baltimore, MD, USA.
Center for Translational Medicine, School of Pharmacy, University of Maryland, Baltimore, MD, USA.
出版信息
J Perinatol. 2019 Oct;39(10):1370-1376. doi: 10.1038/s41372-019-0440-8. Epub 2019 Aug 6.
OBJECTIVE
To determine if racial differences are associated with Neonatal Opioid Withdrawal Syndrome (NOWS) severity.
STUDY DESIGN
A 10-year (2008-2017) retrospective cohort of infants ≥35 weeks gestation with prenatal exposure to opioids was included. The primary measure was the need for pharmacotherapy. Multivariable logistic regression and propensity score analysis were performed.
RESULTS
Among 345 infants with NOWS, 111 (32%) were black infants with 70% of them requiring pharmacotherapy as compared with 84% of white infants. Upon adjusting for significant covariates (methadone, benzodiazepine use, and gestational age), black infants were 57% less likely than whites to require pharmacotherapy (Odds ratio: 0.43, 95%CI: 0.22-0.80, p = 0.009). Similar results were observed with propensity score analysis.
CONCLUSIONS
Significant racial disparity observed may be secondary to genetic variations in opioid pharmacogenomics and/or extrinsic factors. Large-scale studies are warranted to include race in predictive models for early pharmacological intervention.
目的
确定种族差异是否与新生儿阿片类戒断综合征（NOWS）的严重程度有关。
研究设计
本研究纳入了一项为期 10 年（2008-2017 年）的回顾性队列研究，研究对象为≥35 周胎龄且有产前阿片类药物暴露的婴儿。主要测量指标为是否需要药物治疗。进行了多变量逻辑回归和倾向评分分析。
结果
在 345 名患有 NOWS 的婴儿中，有 111 名（32%）是黑人婴儿，其中 70%需要药物治疗，而白人婴儿中这一比例为 84%。在调整了显著的混杂因素（美沙酮、苯二氮䓬类药物使用和胎龄）后，黑人婴儿需要药物治疗的可能性比白人婴儿低 57%（比值比：0.43，95%CI：0.22-0.80，p=0.009）。在倾向评分分析中也观察到了类似的结果。
结论
观察到的显著种族差异可能是由于阿片类药物药物基因组学的遗传变异和/或外在因素造成的。需要进行大规模研究，将种族纳入早期药物干预的预测模型中。
Zotero 插件