Abenhaim L, Moride Y, Brenot F, Rich S, Benichou J, Kurz X, Higenbottam T, Oakley C, Wouters E, Aubier M, Simonneau G, Bégaud B
Centre for Clinical Epidemiology and Community Studies, McGill University, Montreal, Canada.
N Engl J Med. 1996 Aug 29;335(9):609-16. doi: 10.1056/NEJM199608293350901.
Recently, a cluster of patients was observed in France in whom primary pulmonary hypertension developed in patients exposed to derivatives of fenfluramine in appetite suppressants (anorexic agents), which are used for weight control. We investigated the potential role of anorexic agents and other suspected risk factors for primary pulmonary hypertension.
In a case-control study, we assessed 95 patients with primary pulmonary hypertension from 35 centers in France, Belgium, the United Kingdom, and the Netherlands and 355 controls recruited from general practices and matched to the patients' sex and age.
The use of anorexic drugs (mainly derivatives of fenfluramine) was associated with an increased risk of primary pulmonary hypertension (odds ratio with any anorexic-drug use, 6.3; 95 percent confidence interval, 3.0 to 13.2). For the use of anorexic agents in the preceding year, the odds ratio was 10.1 (95 percent confidence interval, 3.4 to 29.9). When anorexic drugs were used to a total of more than three months, the odds ratio was 23.1 (95 percent confidence interval, 6.9 to 77.7). We also confirmed an association with several previously identified risk factors: a family history of pulmonary hypertension, infection with the human immunodeficiency virus, cirrhosis, and use of cocaine or intravenous drugs.
The use of anorexic drugs was associated with the development of primary pulmonary hypertension. Active surveillance for this disease should be considered, particularly since their use is expected to increase in the near future.
最近，在法国观察到一组患者，他们在使用用于控制体重的食欲抑制剂（厌食剂）中的芬氟拉明衍生物后患上了原发性肺动脉高压。我们调查了厌食剂及其他原发性肺动脉高压可疑危险因素的潜在作用。
在一项病例对照研究中，我们评估了来自法国、比利时、英国和荷兰35个中心的95例原发性肺动脉高压患者，以及从普通诊所招募的、与患者性别和年龄相匹配的355名对照者。
使用厌食药物（主要是芬氟拉明衍生物）与原发性肺动脉高压风险增加相关（使用任何厌食药物的比值比为6.3；95%置信区间为3.0至13.2）。对于前一年使用厌食剂的情况，比值比为10.1（95%置信区间为3.4至29.9）。当厌食药物总共使用超过三个月时，比值比为23.1（95%置信区间为6.9至77.7）。我们还证实了与一些先前确定的危险因素有关：肺动脉高压家族史、感染人类免疫缺陷病毒、肝硬化以及使用可卡因或静脉注射药物。
使用厌食药物与原发性肺动脉高压的发生有关。应考虑对此疾病进行积极监测，特别是鉴于预计在不久的将来其使用会增加。
