JAMA：长期服用阿司匹林增加眼病风险

美国研究人员18日公布报告显示，长期服用阿司匹林会使患老年性黄斑变性这种眼病的风险提高一倍。

美国威斯康星大学的研究人员搜集了参与一项眼部研究的近5000名成年人的数据。研究开始时，研究对象的年龄在43岁至86岁之间。他们报告日常服用阿司匹林的情况，并每5年做一次眼部检查。在20年的研究时间里，629人新诊断出患老年性黄斑变性。

研究人员分析结果并校正其他因素后发现，不服用阿司匹林的人患老年性黄斑变性的风险不到1％，而服用阿司匹林10年以上的人患老年性黄斑变性的风险会上升一倍。

研究报告19日将发表在新一期《美国医学会杂志》上。研究人员表示，尽管长期服用阿司匹林的人患老年性黄斑变性的绝对风险不是很高，但由于美国约五分之一的成年人日常服用阿司匹林，这一发现仍应引起关注。

老年性黄斑变性指眼部黄斑区的衰老性改变，多发于45岁以上，患病率随年龄增长而增加，是老年人致盲的重要疾病。

不少欧美国家的医生常建议中老年人每日服用一片阿司匹林，以预防心血管疾病。此前有研究表明，服用阿司匹林可以降低患肠癌风险。

doi:10.1001/jama.2012.65406
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Long-term Use of Aspirin and Age-Related Macular Degeneration

Barbara E. K. Klein, MD, MPH; Kerri P. Howard, MS; Ronald E. Gangnon, PhD; Jennifer O. Dreyer, BS; Kristine E. Lee, MS; Ronald Klein, MD, MPH

Context Aspirin is widely used for relief of pain and for cardioprotective effects. Its use is of concern to ophthalmologists when ocular surgery is being considered and also in the presence of age-related macular degeneration (AMD). Objective To examine the association of regular aspirin use with incidence of AMD. Design, Setting, and Participants The Beaver Dam Eye Study, a longitudinal population-based study of age-related eye diseases conducted in Wisconsin. Examinations were performed every 5 years over a 20-year period (1988-1990 through 2008-2010). Study participants (N = 4926) were aged 43 to 86 years at the baseline examination. At subsequent examinations, participants were asked if they had regularly used aspirin at least twice a week for more than 3 months. Main Outcome Measure Incidence of early AMD, late AMD, and 2 subtypes of late AMD (neovascular AMD and pure geographic atrophy), assessed in retinal photographs according to the Wisconsin Age-Related Maculopathy Grading System. Results The mean duration of follow-up was 14.8 years. There were 512 incident cases of early AMD (of 6243 person-visits at risk) and 117 incident cases of late AMD (of 8621 person-visits at risk) over the course of the study. Regular aspirin use 10 years prior to retinal examination was associated with late AMD (hazard ratio [HR], 1.63 [95% CI, 1.01-2.63]; P = .05), with estimated incidence of 1.76% (95% CI, 1.17%-2.64%) in regular users and 1.03% (95% CI, 0.70%-1.51%) in nonusers. For subtypes of late AMD, regular aspirin use 10 years prior to retinal examination was significantly associated with neovascular AMD (HR, 2.20 [95% CI, 1.20-4.15]; P = .01) but not pure geographic atrophy (HR, 0.66 [95% CI, 0.25-1.95]; P = .45). Aspirin use 5 years (HR, 0.86 [95% CI, 0.71-1.05]; P = .13) or 10 years (HR, 0.86 [95% CI, 0.65-1.13]; P = .28) prior to retinal examination was not associated with incident early AMD. Conclusions Among an adult cohort, aspirin use 5 years prior to observed incidence was not associated with incident early or late AMD. However, regular aspirin use 10 years prior was associated with a small but statistically significant increase in the risk of incident late and neovascular AMD.