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编译服务: 心血管疾病防治 编译者: 张燕舞 编译时间: May 22, 2018 浏 览 量: 1

氟喹诺酮具有可能损害血管壁完整性的非抗微生物特性。 在瑞典进行的一项全国范围队列研究中,与使用阿莫西林相比,氟喹诺酮在治疗开始后60天内与主动脉瘤或夹层事件风险增加相关(每1000人年有1.2例与0.7例;绝对差值为每1例82例 百万次治疗发作),与先前研究中的发现一致。 我们认为,这项新研究不会导致修订2017年美国食品和药物管理局安全通信,指出对现有信息的审查不支持氟喹诺酮类药物引起主动脉瘤或剥离的报道。 如果存在关联,绝对风险很小,并且可能仅限于具有其他易感风险因素的个体。

OBJECTIVE To investigate whether oral fluoroquinolone use is associated with an increased risk of aortic aneurysm or dissection.

DESIGN Nationwide historical cohort study using linked register data on patient characteristics, filled prescriptions, and cases of aortic aneurysm or dissection.

SETTING Sweden, July 2006 to December 2013.

PARTICIPANTS 360 088 treatment episodes of fluoroquinolone use (78%ciprofloxacin) and propensity score matched comparator episodes of amoxicillin use (n=360 088).

MAIN OUTCOME MEASURES Cox regression was used to estimate hazard ratios for a first diagnosis of aortic aneurysm or dissection, defined as admission to hospital or emergency department for, or death due to, aortic aneurysm or dissection, within 60 days from start of treatment.

RESULTS Within the 60 day risk period, the rate of aortic aneurysm or dissection was 1.2 cases per 1000 person years among fluoroquinolone users and 0.7 cases per 1000 person years among amoxicillin users. Fluoroquinolone use was associated with an increased risk of aortic aneurysm or dissection (hazard ratio 1.66 (95% confidence interval 1.12 to 2.46)), with an estimated absolute difference of 82 (95% confidence interval 15 to 181) cases of aortic aneurysm or dissection by 60 days per 1 million treatment episodes. In a secondary analysis, the hazard ratio for the association with fluoroquinolone use was 1.90 (1.22 to 2.96) for aortic aneurysm and 0.93 (0.38 to 2.29) for aortic dissection.

CONCLUSIONS In a propensity score matched cohort, fluoroquinolone use was associated with an increased risk of aortic aneurysm or dissection. This association appeared to be largely driven by aortic aneurysm.

  
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