Department of Neurology, Bispebjerg University Hospital, Copenhagen, Denmark,
Department of Neurology, Bispebjerg University Hospital, Copenhagen, Denmark.
Neuroepidemiology. 2020;54(1):58-63. doi: 10.1159/000503003. Epub 2019 Oct 29.
Multiple system atrophy (MSA) is a rare rapidly progressive atypical Parkinson disorder presenting clinically with parkinsonism and/or a cerebellar syndrome in combination with dysautonomia. Severe neuroinflammation develops along with hallmark neuropathological changes, and as in Parkinson's disease, intake of anti-inflammatory medication has been hypothesized to be protective for development of disease. We aimed to investigate if use of non-aspirin nonsteroidal anti-inflammatory drugs (NSAIDs), low-dose aspirin, or statins were associated with a reduced risk of MSA.
We performed a register-based case-control study in MSA (n = 155) cases and population controls (n= 7,750) matched on age, gender, and place of residency by risk-set sampling. Pharmacological exposure prior to diagnosis was assessed in 2 categories (user vs. nonuser, cumulated dose in tertiles [T1-T3]). In an unconditional logistic regression model, adjusted for age, gender, residency, and chronic obstructive pulmonary disease (COPD), we estimated ORs and 95% CIs.
Data suggested a trend towards non-aspirin NSAID use to be associated with a decreased risk of MSA (OR 0.72 [95% CI 0.49-1.06]) compared to nonusers, decreasing dose-dependently (T2 OR 0.77 [95% CI 0.43-1.38]; T3 OR 0.55 [95% CI 0.29-1.06]). However, data were based on small numbers. Use of statins and low-dose aspirin was not associated with a decreased risk of MSA. Results were lagged 5 years from index date to address reverse causation.
A trend toward use of non-aspirin NSAID and an associated reduced risk of MSA was observed in this study. However, our analyses had limited statistical precision, and further studies including larger sample sizes and longer exposure periods are needed.
多系统萎缩（MSA）是一种罕见的快速进展性非典型帕金森病，临床上表现为帕金森病和/或小脑综合征，同时伴有自主神经功能障碍。严重的神经炎症与标志性的神经病理学变化一起发展，与帕金森病一样，人们假设抗炎药物的摄入对疾病的发展具有保护作用。我们旨在研究使用非阿司匹林非甾体抗炎药（NSAIDs）、低剂量阿司匹林或他汀类药物是否与 MSA 风险降低相关。
我们在 MSA（n=155）病例和人群对照（n=7750）中进行了基于登记的病例对照研究，通过风险集抽样按年龄、性别和居住地进行匹配。在 2 个类别中评估了诊断前的药物暴露情况（使用者与非使用者，累积剂量分为 3 个三分位数 [T1-T3]）。在未调整的逻辑回归模型中，我们调整了年龄、性别、居住地和慢性阻塞性肺疾病（COPD），估计了 OR 和 95%CI。
数据表明，与非使用者相比，非阿司匹林 NSAID 的使用与 MSA 风险降低相关（OR 0.72 [95% CI 0.49-1.06]），且呈剂量依赖性降低（T2 OR 0.77 [95% CI 0.43-1.38]；T3 OR 0.55 [95% CI 0.29-1.06]）。然而，数据基于小样本量。使用他汀类药物和低剂量阿司匹林与 MSA 风险降低无关。结果滞后 5 年从指数日期以解决反向因果关系。
在这项研究中观察到使用非阿司匹林 NSAID 与 MSA 风险降低之间存在趋势。然而，我们的分析统计学精度有限，需要进行包括更大样本量和更长暴露期的进一步研究。
