O'Grady Michael, Clarke Louise, Turner Gregory, Doogue Matt, Purcell Rachel, Pearson John, Frizelle Frank
University of Otago, Christchurch, New Zealand.
John Hunter Hospital, Newcastle, Australia.
Medicine (Baltimore). 2020 May;99(20):e20264. doi: 10.1097/MD.0000000000020264.
The goal of the study was to examine the association between statin use and the development of acute diverticulitis requiring hospital admission.Acute diverticulitis is a common and costly gastrointestinal disorder. Although the incidence is increasing its pathophysiology and modifiable risk factors are incompletely understood. Statins affect the inflammatory response and represent a potential risk reducing agent.A retrospective, population-based, case-control study was carried out on a cohort of adults, resident in Canterbury, New Zealand. All identified cases were admitted to hospital and had computed tomography confirmed diverticulitis. The positive control group comprised patients on non-aspirin nonsteroidal anti-inflammatory drugs (NSAIDs), and the negative control group were patients on selective serotonin reuptake inhibitors (SSRIs). Medicine exposure was obtained from the Pharmaceutical Management Agency of New Zealand. Subgroup analysis was done by age and for complicated and recurrent diverticulitis.During the study period, there were 381,792 adults resident in Canterbury. The annual incidence of diverticulitis requiring hospital presentation was 18.6 per 100,000 per year. Complicated disease was seen in 37.4% (158) of patients, and 14.7% (62) had recurrent disease. Statins were not found to affect the risk of developing acute diverticulitis, nor the risk of complicated or recurrent diverticulitis. Subgroup analysis suggested statin use was associated with a decreased risk of acute diverticulitis in the elderly (age >64 years). NSAIDs were associated with a decreased risk of acute diverticulitis (risk ratio = 0.65, confidence interval: 0.26-0.46, P < .01), as were SSRIs (risk ratio = 0.37, confidence interval: 0.26-0.54, P < .01).This population-based study does not support the hypothesis that statins have a preventative effect on the development of diverticulitis, including complicated disease. We also found a decreased risk of diverticulitis associated with NSAID and SSRI use.
该研究的目的是探讨使用他汀类药物与需住院治疗的急性憩室炎发生之间的关联。急性憩室炎是一种常见且代价高昂的胃肠道疾病。尽管其发病率在上升，但其病理生理学和可改变的风险因素仍未完全明确。他汀类药物会影响炎症反应，是一种潜在的风险降低药物。
对居住在新西兰坎特伯雷地区的成年人群体进行了一项基于人群的回顾性病例对照研究。所有确诊病例均入院治疗，并经计算机断层扫描确诊为憩室炎。阳性对照组为服用非阿司匹林非甾体抗炎药（NSAIDs）的患者，阴性对照组为服用选择性5-羟色胺再摄取抑制剂（SSRIs）的患者。药物暴露信息来自新西兰药品管理局。按年龄以及复杂型和复发性憩室炎进行亚组分析。
在研究期间，坎特伯雷地区有381,792名成年人。需住院治疗的憩室炎年发病率为每10万人每年18.6例。37.4%（158例）的患者患有复杂型疾病，14.7%（62例）有复发性疾病。未发现他汀类药物会影响发生急性憩室炎的风险，也不影响复杂型或复发性憩室炎的风险。亚组分析表明，使用他汀类药物与老年人（年龄>64岁）急性憩室炎风险降低相关。NSAIDs与急性憩室炎风险降低相关（风险比=0.65，置信区间：0.26 - 0.46，P<0.01），SSRIs也是如此（风险比=0.37，置信区间：0.26 - 0.54，P<0.01）。
这项基于人群的研究不支持他汀类药物对憩室炎（包括复杂型疾病）的发生具有预防作用这一假设。我们还发现使用NSAIDs和SSRIs与憩室炎风险降低相关。
