β受体阻滞剂的使用与膝关节置换风险：一项巢式病例对照研究。

The Use of β-Blockers and the Risk of Undergoing a Knee Arthroplasty: A Nested Case-Control Study.

机构信息

Hospital Regional Universitario de Málaga, Málaga, Spain.

Faculty of Medicine, University of Málaga, Málaga, Spain.

出版信息

J Bone Joint Surg Am. 2023 Oct 4;105(19):1494-1501. doi: 10.2106/JBJS.22.01189. Epub 2023 Sep 5.

DOI:10.2106/JBJS.22.01189

PMID:37669477

Abstract

BACKGROUND

Research has indicated that β-blockers may downregulate various inflammatory mediators that are involved in osteoarthritis (OA). The objective of this study was to analyze the likelihood of total knee arthroplasty (TKA) among patients with OA who were being treated with β-blockers.

METHODS

A nested case-control study was conducted with use of clinical records from our institutional database. We included patients who attended our outpatient clinic with a history of new-onset knee pain between 2010 and 2019. The case group included individuals who had undergone primary TKA between 2018 and 2019, whereas the control group included subjects who had not undergone TKA. Controls were matched by date of birth ±2 years, sex, calendar time (first outpatient visit ±1 year), and the grade of arthritis; the control-to-case ratio was 1:1. Adherence to β-blocker use was measured with use of the proportion of days covered (PDC) (i.e.,<0.25, ≥0.25 to <0.75, ≥0.75), and the cumulative effect was measured on the basis of the total number of years of treatment with β-blockers. A binary logistic regression analysis adjusted to potential confounders was carried out to assess the risk of TKA associated with the intake of β-blockers.

RESULTS

A total of 600 patients were included (300 in the case group and 300 in the control group). Compared with non-users, any use of β-blockers during the follow-up period was associated with a reduction in the likelihood of undergoing TKA (adjusted odds ratio [OR], 0.51; 95% confidence interval [CI], 0.34-0.77). The adjusted ORs for the use of selective β1-blockers and nonselective β1-blockers were 0.69 (95% CI, 0.36 to 1.31) and 0.42 (95% CI, 0.24 to 0.70), respectively. The adjusted ORs for any recent use, PDC of <0.25, PDC of ≥0.25 to <0.75, and PDC of ≥0.75 were 0.65 (95% CI, 0.51 to 0.99), 0.62 (95% CI, 0.21 to 1.85), 0.32 (95% CI, 0.09 to 1.22), and 0.55 (95% CI, 0.34 to 0.88), respectively. Regarding the cumulative effect of β-blockers, the adjusted ORs for the use for <1 year, ≥1 to <5 years, and ≥5 years were 0.41 (95% CI, 0.20 to 0.85), 0.52 (95% CI, 0.21 to 1.33), and 0.36 (95% CI, 0.22 to 0.60), respectively.

CONCLUSIONS

The use of nonselective β-blockers was associated with a lower likelihood of undergoing TKA. Patients treated for prolonged periods were at a lower likelihood for undergoing TKA.

LEVEL OF EVIDENCE

Prognostic Level III . See Instructions for Authors for a complete description of levels of evidence.

摘要

背景

研究表明，β受体阻滞剂可能会下调与骨关节炎（OA）相关的各种炎症介质。本研究的目的是分析接受β受体阻滞剂治疗的 OA 患者行全膝关节置换术（TKA）的可能性。

方法

本研究采用来自我们机构数据库的临床记录进行巢式病例对照研究。我们纳入了 2010 年至 2019 年期间在我院门诊就诊且新出现膝关节疼痛的患者。病例组包括 2018 年至 2019 年期间接受初次 TKA 的患者，对照组包括未接受 TKA 的患者。通过出生日期±2 年、性别、就诊时间（±1 年）和关节炎程度对对照组进行匹配；病例组与对照组的比例为 1:1。通过使用比例天数覆盖（PDC）（即<0.25、≥0.25 至<0.75、≥0.75）来衡量β受体阻滞剂的使用依从性，并根据β受体阻滞剂治疗的总年数来衡量累积效应。采用调整潜在混杂因素的二元逻辑回归分析来评估β受体阻滞剂的摄入与 TKA 风险之间的相关性。

结果

共纳入 600 例患者（病例组 300 例，对照组 300 例）。与非使用者相比，在随访期间使用任何β受体阻滞剂均与 TKA 可能性降低相关（调整后的比值比 [OR]，0.51；95%置信区间 [CI]，0.34-0.77）。选择性β1受体阻滞剂和非选择性β1受体阻滞剂的调整后 OR 分别为 0.69（95% CI，0.36 至 1.31）和 0.42（95% CI，0.24 至 0.70）。最近使用任何β受体阻滞剂、PDC<0.25、PDC≥0.25 至<0.75 和 PDC≥0.75 的调整后 OR 分别为 0.65（95% CI，0.51 至 0.99）、0.62（95% CI，0.21 至 1.85）、0.32（95% CI，0.09 至 1.22）和 0.55（95% CI，0.34 至 0.88）。关于β受体阻滞剂的累积效应，使用<1 年、≥1 至<5 年和≥5 年的调整后 OR 分别为 0.41（95% CI，0.20 至 0.85）、0.52（95% CI，0.21 至 1.33）和 0.36（95% CI，0.22 至 0.60）。