Department of Anesthesiology, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University, Taoyuan City, Taiwan.
Department of Cardiology, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University, Taoyuan City, Taiwan.
PLoS One. 2024 Jul 24;19(7):e0307480. doi: 10.1371/journal.pone.0307480. eCollection 2024.
Recently, there have been conflicting results reporting an increased risk of AR or MR associated with oral fluoroquinolones (FQs).This study investigated whether the use of FQs increases the risk of mitral regurgitation (MR) or aortic regurgitation (AR).
A retrospective cohort study was conducted by using the Taiwan National Health Insurance research database. A unidirectional case-crossover design without selecting controls from an external population was adopted in this study. A total of 26,650 adult patients with new onset of AR or MR between January 1, 2000, and December 31, 2012, were identified. The risk of outcomes was compared between the hazard period and one of the randomly selected referent periods of the same individuals.
Before exclusion of pneumonia diagnosed within 2 months before the index date, patients who took FQs had a significantly greater risk of AR or MR (adjusted odds ratio [aOR] 1.51, 95% confidence interval [CI] 1.30-1.77), any AR (combined AR and MR) (aOR 1.50, 95% CI 1.10-2.04), and any MR (combined AR and MR) (aOR 1.37, 95% CI 1.16-1.62). After exclusion of pneumonia, FQs exposure remained significantly associated with a greater risk of MR (aOR 1.38, 95% CI 1.17-1.62) and any MR (aOR 1.25, 95% CI 1.05-1.48).
The findings suggested that patients treated with FQs could be warned about the potential risk for MR even after considering the possibility of protopathic bias. Reducing unnecessary FQs prescriptions may be considered to reduce the risk of valvular heart disease.
最近，有一些相互矛盾的研究结果报告称，口服氟喹诺酮类药物（FQs）与 AR 或 MR 的风险增加有关。本研究旨在探讨 FQs 的使用是否会增加二尖瓣反流（MR）或主动脉瓣反流（AR）的风险。
本研究采用回顾性队列研究，使用台湾全民健康保险研究数据库。本研究采用单向病例交叉设计，不选择来自外部人群的对照。共纳入 2000 年 1 月 1 日至 2012 年 12 月 31 日期间新诊断为 AR 或 MR 的 26650 例成年患者。比较风险期和同一患者随机选择的一个参考期之间的结果风险。
在排除索引日期前 2 个月内诊断的肺炎之前，服用 FQs 的患者发生 AR 或 MR 的风险显著增加（调整后的优势比[aOR]1.51，95%置信区间[CI]1.30-1.77）、任何 AR（AR 和 MR 联合）（aOR 1.50，95%CI 1.10-2.04）和任何 MR（AR 和 MR 联合）（aOR 1.37，95%CI 1.16-1.62）。排除肺炎后，FQs 暴露仍与 MR（aOR 1.38，95%CI 1.17-1.62）和任何 MR（aOR 1.25，95%CI 1.05-1.48）风险增加显著相关。
即使考虑到前驱性偏倚的可能性，研究结果表明，使用 FQs 治疗的患者可能需要警惕 MR 的潜在风险。减少不必要的 FQs 处方可能有助于降低瓣膜性心脏病的风险。
