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BMJ:血管紧张素转换酶抑制剂和肺癌风险

2018-10-25 xing.T MedSci原创

在这项基于人群的队列研究中,ACEI的使用与肺癌风险增加有关。使用ACEI超过五年的人群中这种关联特别明显。需要进行长期随访的研究以确定这些药物对肺癌发病率的影响。

近日,顶级杂志BMJ上发表了一篇研究文章,与服用血管紧张素受体阻滞剂相比,研究人员旨在明确血管紧张素转换酶抑制剂(ACEIs)的使用是否与肺癌风险增加有关。

该研究为基于人群的队列研究,以英国临床实践研究数据链为基础。 参与者为在1995年1月1日至2015年12月31日期间接受抗高血压药物治疗的992061名患者,并随访至2016年12月31日。Cox比例风险模型用于估计与使用ACEI相关的肺癌事件调整后风险比和95%置信区间。

该队列平均随访6.4(SD为4.7)年,共发生7952例肺癌事件(粗略发病率为1.3(95%置信区间为1.2-1.3)/1000人每年)。总体而言,与使用血管紧张素受体阻滞剂相比,使用ACEI与肺癌风险增加相关(发病率为1.6 vs  1.2/1000人每年;风险比为1.14,95%置信区间为1.01-1.29)。随着使用时间的延长,风险比逐渐增加,使用五年后风险显著(风险比为1.22,1.06-1.40),使用超过10年后达到峰值(1.31,1.08-1.59)。自服药以来随着时间推移观察到了类似的结果。

在这项基于人群的队列研究中,ACEI的使用与肺癌风险增加有关。使用ACEI超过五年的人群中这种关联特别明显。需要进行长期随访的研究以确定这些药物对肺癌发病率的影响。

原始出处:

Blánaid M Hicks, et al. Angiotensin converting enzyme inhibitors and risk of lung cancer: population based cohort study.BMJ 2018; https://www.bmj.com/content/363/bmj.k4209

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    2019-08-06 jklm09
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    2019-04-27 爆笑小医
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beContent=null, objectType=article, channel=null, level=null, likeNumber=79, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTLbTp9nZtjwVrSZNxAXbAicnKQWnic2eBdJUQYhxO36XdkstSicr7FVF8p5ReH4omtmsbnLdvZLiaJJ1A/132, createdBy=8bff2327056, createdName=kafei, createdTime=Fri Oct 26 12:52:19 CST 2018, time=2018-10-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=350569, encodeId=d66135056939, content=难以置信啊,居然也和肺癌有关吗, beContent=null, objectType=article, channel=null, level=null, likeNumber=75, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4NdicLmdJEK9VoiaDianY6fzHNN9iaGv80m39pMHU3eSnNN0kn1o0rdQ7Bz2f03Qibcf1ia7rKvxIt4UVlErF2d4gCmDC5/0, createdBy=98e31740255, createdName=cqykthl, createdTime=Fri Oct 26 12:43:28 CST 2018, time=2018-10-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=350535, encodeId=b31a35053540, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=55, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1bb241978, createdName=phoebeyan520, createdTime=Fri Oct 26 06:40:53 CST 2018, time=2018-10-26, status=1, ipAttribution=)]
    2019-07-22 sjq027
  5. 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beContent=null, objectType=article, channel=null, level=null, likeNumber=79, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTLbTp9nZtjwVrSZNxAXbAicnKQWnic2eBdJUQYhxO36XdkstSicr7FVF8p5ReH4omtmsbnLdvZLiaJJ1A/132, createdBy=8bff2327056, createdName=kafei, createdTime=Fri Oct 26 12:52:19 CST 2018, time=2018-10-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=350569, encodeId=d66135056939, content=难以置信啊,居然也和肺癌有关吗, beContent=null, objectType=article, channel=null, level=null, likeNumber=75, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4NdicLmdJEK9VoiaDianY6fzHNN9iaGv80m39pMHU3eSnNN0kn1o0rdQ7Bz2f03Qibcf1ia7rKvxIt4UVlErF2d4gCmDC5/0, createdBy=98e31740255, createdName=cqykthl, createdTime=Fri Oct 26 12:43:28 CST 2018, time=2018-10-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=350535, encodeId=b31a35053540, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=55, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1bb241978, createdName=phoebeyan520, createdTime=Fri Oct 26 06:40:53 CST 2018, time=2018-10-26, status=1, ipAttribution=)]
    2018-10-28 1e145228m78(暂无匿称)

    学习了,谢谢作者分享!

    0

  6. 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  7. 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ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=350535, encodeId=b31a35053540, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=55, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1bb241978, createdName=phoebeyan520, createdTime=Fri Oct 26 06:40:53 CST 2018, time=2018-10-26, status=1, ipAttribution=)]
  8. 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beContent=null, objectType=article, channel=null, level=null, likeNumber=79, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTLbTp9nZtjwVrSZNxAXbAicnKQWnic2eBdJUQYhxO36XdkstSicr7FVF8p5ReH4omtmsbnLdvZLiaJJ1A/132, createdBy=8bff2327056, createdName=kafei, createdTime=Fri Oct 26 12:52:19 CST 2018, time=2018-10-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=350569, encodeId=d66135056939, content=难以置信啊,居然也和肺癌有关吗, beContent=null, objectType=article, channel=null, level=null, likeNumber=75, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4NdicLmdJEK9VoiaDianY6fzHNN9iaGv80m39pMHU3eSnNN0kn1o0rdQ7Bz2f03Qibcf1ia7rKvxIt4UVlErF2d4gCmDC5/0, createdBy=98e31740255, createdName=cqykthl, createdTime=Fri Oct 26 12:43:28 CST 2018, time=2018-10-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=350535, encodeId=b31a35053540, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=55, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1bb241978, createdName=phoebeyan520, createdTime=Fri Oct 26 06:40:53 CST 2018, time=2018-10-26, status=1, ipAttribution=)]
    2018-10-26 kafei

    学习了谢谢

    0

  9. 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beContent=null, objectType=article, channel=null, level=null, likeNumber=79, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTLbTp9nZtjwVrSZNxAXbAicnKQWnic2eBdJUQYhxO36XdkstSicr7FVF8p5ReH4omtmsbnLdvZLiaJJ1A/132, createdBy=8bff2327056, createdName=kafei, createdTime=Fri Oct 26 12:52:19 CST 2018, time=2018-10-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=350569, encodeId=d66135056939, content=难以置信啊,居然也和肺癌有关吗, beContent=null, objectType=article, channel=null, level=null, likeNumber=75, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4NdicLmdJEK9VoiaDianY6fzHNN9iaGv80m39pMHU3eSnNN0kn1o0rdQ7Bz2f03Qibcf1ia7rKvxIt4UVlErF2d4gCmDC5/0, createdBy=98e31740255, createdName=cqykthl, createdTime=Fri Oct 26 12:43:28 CST 2018, time=2018-10-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=350535, encodeId=b31a35053540, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=55, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1bb241978, createdName=phoebeyan520, createdTime=Fri Oct 26 06:40:53 CST 2018, time=2018-10-26, status=1, ipAttribution=)]
    2018-10-26 cqykthl

    难以置信啊,居然也和肺癌有关吗

    0

  10. 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beContent=null, objectType=article, channel=null, level=null, likeNumber=79, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTLbTp9nZtjwVrSZNxAXbAicnKQWnic2eBdJUQYhxO36XdkstSicr7FVF8p5ReH4omtmsbnLdvZLiaJJ1A/132, createdBy=8bff2327056, createdName=kafei, createdTime=Fri Oct 26 12:52:19 CST 2018, time=2018-10-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=350569, encodeId=d66135056939, content=难以置信啊,居然也和肺癌有关吗, beContent=null, objectType=article, channel=null, level=null, likeNumber=75, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4NdicLmdJEK9VoiaDianY6fzHNN9iaGv80m39pMHU3eSnNN0kn1o0rdQ7Bz2f03Qibcf1ia7rKvxIt4UVlErF2d4gCmDC5/0, createdBy=98e31740255, createdName=cqykthl, createdTime=Fri Oct 26 12:43:28 CST 2018, time=2018-10-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=350535, encodeId=b31a35053540, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=55, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1bb241978, createdName=phoebeyan520, createdTime=Fri Oct 26 06:40:53 CST 2018, time=2018-10-26, status=1, ipAttribution=)]
    2018-10-26 phoebeyan520

    学习了

    0

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由此可见,这项评估心脏手术前常规继续服用或停用ACEI或ARB的随机研究是可行的,并且治疗分配与术后生理或临床结局的差异无关。

J Am Soc Nephrol:ACEI早期蛋白尿降低可预测CKD患儿的肾存活?

2018年8月,发表在《J Am Soc Nephrol》的一项由荷兰和德国学者进行的研究,考察了血管紧张素转换酶抑制剂(ACEI)初始降低蛋白尿作用在CKD患儿中能否获得同成人一样的肾保护作用。

Pharmacoepidemiol Drug Saf:ACEI竟与急性胰腺炎风险增加相关

2017年7月,发表在《Pharmacoepidemiol Drug Saf》的一项由芬兰科学家进行的基于人群的病例对照研究,考察了血管紧张素转换酶抑制剂(ACEI)与急性胰腺炎风险之间的相关性。

肾病患者使用ACEI类降压药,有何注意事项

我们常见的降压药物种类包括血管紧张素转化酶抑制(ACEI,如卡托普利、伊那普利、雷米普利),血管紧张素Ⅱ受体阻断剂,α受体阻滞剂,β受体阻滞剂,钙离子拮抗剂,利尿剂。其中,血管紧张素转化酶抑制剂(ACEI)通过抑制血管紧张素II生成,阻断肾素-血管紧张素-醛固酮系统,抑制缓激肽降解、增强缓激肽效应。不仅可降压,同时还可减少心肌重构,改善心血管病患者预后。

JASN:血管紧张素转换酶抑制剂降低蛋白尿可预测CKD患儿肾脏存活情况

由此可见,ACE抑制剂的早期抗蛋白尿作用与CKD患儿长期保留的肾功能有关。蛋白尿降低应该被认为是儿科CKD治疗的重要目标。

JACC:心血管病患者应首选ARB,而非ACEI

多数心血管病指南均推荐首选血管紧张素转换酶抑制剂(ACEI),只有当ACEI不耐受时,才建议使用血管紧张素受体阻滞剂(ARB)。

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