吸入性皮质类固醇对 COPD-支气管扩张症重叠患者肺炎风险的影响：一项基于英国人群的病例对照研究。
The Effect of Inhaled Corticosteroids on Pneumonia Risk in Patients With COPD-Bronchiectasis Overlap: A UK Population-Based Case-Control Study.
机构信息
National Heart and Lung Institute, Imperial College London, London, England.
National Heart and Lung Institute, Imperial College London, London, England; Department of Infectious Disease, Imperial College London, London, England.
出版信息
Chest. 2023 Oct;164(4):875-884. doi: 10.1016/j.chest.2023.06.007. Epub 2023 Jun 17.
BACKGROUND
Inhaled corticosteroids (ICS) increase the risk of pneumonia in COPD and commonly are used in patients with COPD-bronchiectasis overlap.
RESEARCH QUESTION
Is the risk of pneumonia associated with ICS further heightened in COPD-bronchiectasis?
STUDY DESIGN AND METHODS
Electronic health care records (from 2004-2019) were used to obtain a cohort of patients with COPD and a nested case-control group (age and sex matched 1:4). Analyses were conducted to determine the risk of hospitalization for pneumonia in COPD associated with ICS use in those with bronchiectasis. Findings were confirmed by several sensitivity analyses. Additionally, a smaller nested case-control group containing only patients with COPD-bronchiectasis overlap and those with recent blood eosinophil counts (BECs) was used to determine any association with BEC.
RESULTS
Three hundred sixteen thousand six hundred sixty-three patients were eligible for the COPD cohort; bronchiectasis significantly increased the risk of pneumonia (adjusted hazard ratio, 1.24; 95% CI, 1.15-1.33). In the first nested case-control group of 84,316 patients with COPD, ICS was found to increase the odds of pneumonia (adjusted OR [AOR], 1.26; 95% CI, 1.19-1.32) only if used in the previous 180 days. However, bronchiectasis was a significant modifier such that ICS use did not augment further the already elevated bronchiectasis-associated pneumonia risk (COPD-bronchiectasis: AOR, 1.01; 95% CI, 0.8-1.28; no bronchiectasis: AOR, 1.27; 95% CI, 1.20-1.34). Several sensitivity analyses and a second smaller nested case-control group confirmed these findings. Finally, we found that BEC modified the ICS-associated pneumonia risk in COPD-bronchiectasis overlap, where lower BEC was associated significantly with pneumonia (BEC ≤ 3 × 10/L: AOR, 1.56; 95% CI, 1.05-2.31; BEC > 3 × 10/L: AOR, 0.89; 95% CI, 0.53-1.24).
INTERPRETATION
ICS use does not augment further the already increased risk of hospitalization for pneumonia associated with concomitant bronchiectasis in patients with COPD.
背景
吸入性皮质类固醇（ICS）会增加 COPD 患者肺炎的风险，并且通常用于 COPD-支气管扩张症重叠患者。
研究问题
ICS 是否会进一步增加 COPD-支气管扩张症患者的肺炎风险？
研究设计和方法
使用电子医疗记录（2004-2019 年）获得 COPD 患者队列和嵌套病例对照组（年龄和性别匹配 1:4）。进行分析以确定在患有支气管扩张症的患者中，ICS 使用与肺炎住院风险相关。通过几项敏感性分析证实了研究结果。此外，还使用仅包含 COPD-支气管扩张症重叠患者和最近血嗜酸性粒细胞计数（BEC）的较小嵌套病例对照组来确定与 BEC 的任何关联。
结果
有 316636 名患者符合 COPD 队列的条件；支气管扩张症显著增加了肺炎的风险（调整后的危险比，1.24；95%CI，1.15-1.33）。在包含 84316 名 COPD 患者的第一个嵌套病例对照组中，发现 ICS 增加了肺炎的可能性（调整后的比值比 [AOR]，1.26；95%CI，1.19-1.32），但前提是在过去 180 天内使用。然而，支气管扩张症是一个显著的修饰因子，因此 ICS 的使用并没有进一步增加已经升高的支气管扩张症相关肺炎风险（COPD-支气管扩张症：AOR，1.01；95%CI，0.8-1.28；无支气管扩张症：AOR，1.27；95%CI，1.20-1.34）。几项敏感性分析和第二个较小的嵌套病例对照组证实了这些发现。最后，我们发现 BEC 修饰了 COPD-支气管扩张症重叠患者中 ICS 相关肺炎的风险，其中较低的 BEC 与肺炎显著相关（BEC≤3×10/L：AOR，1.56；95%CI，1.05-2.31；BEC＞3×10/L：AOR，0.89；95%CI，0.53-1.24）。
解释
在 COPD 患者中，ICS 的使用不会进一步增加与同时存在的支气管扩张症相关的肺炎住院风险。
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