Lai Chih-Cheng, Wang Ya-Hui, Chen Kuang-Hung, Chen Chao-Hsien, Wang Cheng-Yi
Department of Internal Medicine, Kaohsiung Veterans General Hospital, Tainan Branch, Tainan 710, Taiwan.
Medical Research Center, Cardinal Tien Hospital and School of Medicine, College of Medicine, Fu Jen Catholic University, New Taipei City 242062, Taiwan.
Antibiotics (Basel). 2021 Jun 10;10(6):697. doi: 10.3390/antibiotics10060697.
This study aimed to investigate the association between the risk of aortic aneurysm (AA)/aortic dissection (AD) and the use of fluoroquinolones (FQs). PubMed, Embase, Cochrane CENTRAL, Cochrane Database of Systematic Reviews, Web of Science and Scopus were searched for relevant articles to 21st February 2021. Studies that compared the risk of AA/AD in patients who did and did not receive FQs or other comparators were included. The pooled results of nine studies with 11 study cohorts showed that the use of FQs increased the risk of AA/AD by 69% (pooled risk ratio (RR) = 1.69 (95% CI = 1.08, 2.64)). This significant association remained unchanged using leave-one-out sensitivity test analysis. Similar results were found for AA (pooled RR = 1.58 (1.21, 2.07)) but no significant association was observed for AD (pooled RR = 1.23 (0.93, 1.62)). Stratified by the comparators, the use of FQs was associated with a significantly higher risk of AA/AD compared to azithromycin (pooled RR = 2.31 (1.54, 3.47)) and amoxicillin (pooled RR = 1.57 (1.39, 1.78)). In contrast, FQ was not associated with a higher risk of AA/AD, when compared with amoxicillin/clavulanic acid or ampicillin/sulbactam (pooled RR = 1.18 (0.81, 1.73)), sulfamethoxazole-trimethoprim (pooled RR = 0.89 (0.65, 1.22)) and other antibiotics (pooled RR = 1.14 (0.90, 1.46)). In conclusion, FQs were associated with an increased risk of AA or AD, although the level of evidence was not robust. However, FQs did not exhibit a higher risk of AA or AD compared with other broad-spectrum antibiotics. Further studies are warranted to clarify the role of FQs in the development of AA or AD.
本研究旨在调查主动脉瘤（AA）/主动脉夹层（AD）风险与氟喹诺酮类药物（FQs）使用之间的关联。检索了PubMed、Embase、Cochrane CENTRAL、Cochrane系统评价数据库、Web of Science和Scopus，以查找截至2021年2月21日的相关文章。纳入了比较接受和未接受FQs或其他对照药物的患者中AA/AD风险的研究。9项研究（共11个研究队列）的汇总结果显示，使用FQs使AA/AD风险增加了69%（汇总风险比（RR）=1.69（95%置信区间=1.08，2.64））。使用留一法敏感性检验分析时，这种显著关联保持不变。AA也有类似结果（汇总RR=1.58（1.21，2.07）），但AD未观察到显著关联（汇总RR=1.23（0.93，1.62））。按对照药物分层，与阿奇霉素相比，使用FQs与AA/AD风险显著更高相关（汇总RR=2.31（1.54，3.47）），与阿莫西林相比也如此（汇总RR=1.57（1.39，1.78））。相比之下，与阿莫西林/克拉维酸或氨苄西林/舒巴坦相比（汇总RR=1.18（0.81，1.73））、与磺胺甲恶唑-甲氧苄啶相比（汇总RR=0.89（0.65，1.22））以及与其他抗生素相比（汇总RR=1.14（0.90，1.46）），FQs与AA/AD风险升高无关。总之，FQs与AA或AD风险增加相关，尽管证据水平并不确凿。然而，与其他广谱抗生素相比，FQs并未表现出更高的AA或AD风险。有必要进一步开展研究以阐明FQs在AA或AD发生发展中的作用。
