Department of Allergy and Clinical Immunology, Chiba University Hospital, Chiba, Japan.
Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan.
Rheumatology (Oxford). 2024 May 3;63(6):1507-1511. doi: 10.1093/rheumatology/kead343.
To evaluate the effectiveness of early initiation of angiotensin-converting enzyme inhibitor (ACEi) in patients with scleroderma renal crisis (SRC).
This was a retrospective cohort study using a nationwide inpatient database in Japan from July 2010 to March 2020. All hospitalized patients with SRC were divided into those who received ACEi within 2 days of admission (early ACEi group) and those who did not (control group). Propensity-score overlap weighting analysis was performed to adjust for confounding factors. The primary outcome was the composite of in-hospital mortality or haemodialysis dependence at discharge.
Of the 475 eligible patients, 248 (52.2%) were in the early ACEi group and 227 (47.8%) were in the control group. After overlap weighting, the primary outcome was significantly lower in the early ACEi group than in the control group (40.1% vs 49.0%; odds ratio, 0.69; 95% CI: 0.48, 1.00; P = 0.049).
The present study showed that early initiation of ACEi was associated with lower composite outcome of in-hospital mortality or haemodialysis dependence at discharge in patients with SRC. Further prospective studies are warranted to verify the present findings.
评估血管紧张素转换酶抑制剂（ACEi）早期给药在硬皮病肾危象（SRC）患者中的疗效。
这是一项回顾性队列研究，使用了日本 2010 年 7 月至 2020 年 3 月期间的全国住院患者数据库。所有 SRC 住院患者均分为入院后 2 天内接受 ACEi 治疗的（早期 ACEi 组）和未接受 ACEi 治疗的（对照组）。采用倾向评分重叠加权分析调整混杂因素。主要结局为住院期间死亡或出院时依赖血液透析的复合结局。
在 475 名符合条件的患者中，248 名（52.2%）在早期 ACEi 组，227 名（47.8%）在对照组。重叠加权后，早期 ACEi 组的主要结局明显低于对照组（40.1% vs 49.0%；比值比，0.69；95%置信区间：0.48，1.00；P=0.049）。
本研究表明，SRC 患者早期使用 ACEi 与住院期间死亡或出院时依赖血液透析的复合结局降低相关。需要进一步的前瞻性研究来验证本研究结果。
