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【文摘发布】COPD患者吸入激素与罹患肺癌危险性
Authorsa:Tanyalak Parimon1,*, Jason W. Chien1,2,*, Chris L. Bryson1,3, Mary B. McDonell3, Edmunds M. Udris1,2 and David H. Au1,3
Resource:American Journal of Respiratory and Critical Care Medicine Vol 175. pp. 712-719, (2007)
Rationale and Objectives: Lung cancer is a frequent cause of death among patients with chronic obstructive pulmonary disease (COPD). We examined whether the use of inhaled corticosteroids among patients with COPD was associated with a decreased risk of lung cancer.
Methods: We performed a cohort study of United States veterans enrolled in primary care clinics between December 1996 and May 2001. Participants had received treatment for, had an International Classification of Disease, 9th edition, diagnosis of, or a self-reported diagnosis of COPD. Patients with a history of lung cancer were excluded. To be exposed, patients must have been at least 80% adherent to inhaled corticosteroids. We used Cox regression models to estimate the risk of cancer and adjust for potential confounding factors.
Findings: We identified 10,474 patients with a median follow-up of 3.8 years. In comparison to nonusers of inhaled corticosteroids, adjusting for age, smoking status, smoking intensity, previous history of non–lung cancer malignancy, coexisting illnesses, and bronchodilator use, there was a dose-dependent decreased risk of lung cancer associated with inhaled corticosteroids (ICS dose < 1,200 µg/d: adjusted HR, 1.3; 95% confidence interval, 0.67–1.90; ICS dose 1,200 µg/d: adjusted HR, 0.39; 95% confidence interval, 0.16–0.96). Changes in cohort definitions had minimal effects on the estimated risk. Analyses examining confounding by indication suggest biases in the opposite direction of the described effects.
Interpretation: Results suggest that inhaled corticosteroids may have a potential role in lung cancer prevention among patients with COPD. These initial findings require confirmation in separate and larger cohorts. 本人已认领该文编译，48小时后若未提交译文，请其他战友自由认领。 Inhaled Corticosteroids and Risk of Lung Cancer among Patients with Chronic Obstructive Pulmonary Disease
COPD（慢性阻塞性肺病）患者吸入激素与罹患肺癌危险性
Authorsa:Tanyalak Parimon1,*, Jason W. Chien1,2,*, Chris L. Bryson1,3, Mary B. McDonell3, Edmunds M. Udris1,2 and David H. Au1,3
Resource:American Journal of Respiratory and Critical Care Medicine Vol 175. pp. 712-719, (2007)
来源：美国呼吸和危重监护杂质.175卷.712-719，（2007）
Rationale and Objectives: Lung cancer is a frequent cause of death among patients with chronic obstructive pulmonary disease (COPD). We examined whether the use of inhaled corticosteroids among patients with COPD was associated with a decreased risk of lung cancer.
原理和目的：肺癌是慢性阻塞性肺病（COPD）患者常见的致死原因。我们对COPD患者使用吸入性激素是否与肺癌风险降低有关进行了调查。
Methods: We performed a cohort study of United States veterans enrolled in primary care clinics between December 1996 and May 2001. Participants had received treatment for, had an International Classification of Disease, 9th edition, diagnosis of, or a self-reported diagnosis of COPD. Patients with a history of lung cancer were excluded. To be exposed, patients must have been at least 80% adherent to inhaled corticosteroids. We used Cox regression models to estimate the risk of cancer and adjust for potential confounding factors.
方法：我们对1996年12月到2001年5月间登记参加初级临床护理的美国退伍军人进行了一项群组研究。参加者或者因COPD接受过治疗，或按第九版国际疾病分类诊断出COPD，或者根据一种自报式诊断出COPD。排出有肺癌史的患者。参加此项研究，患者必须至少80％坚持吸入激素。我们使用Cox回归模型来估计罹患癌症的风险并根据潜在的混淆因素进行校正。
Findings: We identified 10,474 patients with a median follow-up of 3.8 years. In comparison to nonusers of inhaled corticosteroids, adjusting for age, smoking status, smoking intensity, previous history of non–lung cancer malignancy, coexisting illnesses, and bronchodilator use, there was a dose-dependent decreased risk of lung cancer associated with inhaled corticosteroids (ICS dose < 1,200 µg/d: adjusted HR, 1.3; 95% confidence interval, 0.67–1.90; ICS dose 1,200 µg/d: adjusted HR, 0.39; 95% confidence interval, 0.16–0.96). Changes in cohort definitions had minimal effects on the estimated risk. Analyses examining confounding by indication suggest biases in the opposite direction of the described effects.
结果：我们在中位3.8年的随访期内确定了10474名患者。相比未使用吸入性激素的患者，在对年龄、是否吸烟、吸烟强度、非肺癌恶性肿瘤史、并存疾病及是否使用支气管扩张剂等进行校正后，肺癌的发生风险与吸入激素有一种剂量依赖性的下降（ICS剂量< 1,200 µg/d：校正HR, 1.3; 95%置信区间，0.67-1.90；ICS剂量1200µg/d：校正HR，0.39；95％置信区间，0.16-0.96）。改变群组定义，使其对风险评价的影响最小化。通过指出在反方向描绘结果的暗含偏差来分析混淆因素。
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作者:admin@医学,生命科学 2010-12-24 17:30
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