Perneger T V, Whelton P K, Klag M J
Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University School of Hygiene and Public Health, Baltimore.
N Engl J Med. 1994 Dec 22;331(25):1675-9. doi: 10.1056/NEJM199412223312502.
People who take analgesic drugs frequently may be at increased risk of end-stage renal disease (ESRD), but the extent of this risk remains unclear.
We studied 716 patients treated for ESRD and 361 control subjects of similar age from Maryland, Virginia, West Virginia, and Washington, D.C. The study participants were interviewed by telephone about their past use of medications containing acetaminophen, aspirin, and other nonsteroidal antiinflammatory drugs (NSAIDs). For each analgesic drug, the average use (in pills per year) and the cumulative intake (in pills) were examined for any association with ESRD.
Heavier acetaminophen use was associated with an increased risk of ESRD in a dose-dependent fashion. When persons who took an average of 0 to 104 pills per year were used for reference, the odds ratio of ESRD was 1.4 (95 percent confidence interval, 0.8 to 2.4) for those who took 105 to 365 pills per year and 2.1 (95 percent confidence interval, 1.1 to 3.7) for those who took 366 or more pills per year, after adjustment for race, sex, age, and intake of other analgesic drugs. When persons who had taken fewer than 1000 pills containing acetaminophen in their lifetime were used for reference, the odds ratio was 2.0 (95 percent confidence interval, 1.3 to 3.2) for those who had taken 1000 to 4999 pills and 2.4 (95 percent confidence interval, 1.2 to 4.8) for those who had taken 5000 or more pills. Approximately 8 to 10 percent of the overall incidence of ESRD was attributable to acetaminophen use. A cumulative dose of 5000 or more pills containing NSAIDs was also associated with an increased odds of ESRD (odds ratio, 8.8), but the use of aspirin was not.
People who often take acetaminophen or NSAIDs have an increased risk of ESRD, but not those who often take aspirin.
经常服用止痛药物的人可能患终末期肾病（ESRD）的风险增加，但这种风险的程度仍不明确。
我们研究了716例接受ESRD治疗的患者以及来自马里兰州、弗吉尼亚州、西弗吉尼亚州和华盛顿特区的361名年龄相仿的对照者。通过电话采访研究参与者，了解他们过去使用含对乙酰氨基酚、阿司匹林和其他非甾体抗炎药（NSAIDs）药物的情况。对于每种止痛药物，检查其平均使用量（每年服用的片数）和累积摄入量（片数）与ESRD之间的任何关联。
对乙酰氨基酚使用量越大，患ESRD的风险越高，呈剂量依赖性。以每年平均服用0至104片的人群为参照，每年服用105至365片的人群患ESRD的比值比为1.4（95%置信区间为0.8至2.4），每年服用366片及以上的人群患ESRD的比值比为2.1（95%置信区间为1.1至3.7），校正种族、性别、年龄和其他止痛药物的摄入量后。以一生中服用对乙酰氨基酚片数少于1000片的人群为参照，服用1000至4999片的人群患ESRD的比值比为2.0（95%置信区间为1.3至3.2），服用5000片及以上的人群患ESRD的比值比为2.4（95%置信区间为1.2至4.8）。ESRD总体发病率中约8%至10%可归因于对乙酰氨基酚的使用。NSAIDs累积剂量达到5000片及以上也与ESRD几率增加相关（比值比为8.8），但阿司匹林的使用与ESRD无关。
经常服用对乙酰氨基酚或NSAIDs的人患ESRD的风险增加，但经常服用阿司匹林的人则不然。
