長期應用苯溴馬隆可顯著降低痛風患者冠心病發生風險

文獻來源：Hsiu-Chen Lin et al, International Journal of Cardiology 233 (2017) 85–90.

全文內容摘要

背景:

痛風對冠狀動脈疾病(CAD)進展的作用與風險並不確定，有研究發現痛風是急性心肌梗死的危險因素。本文研究調查痛風病人服用苯溴馬隆或別嘌呤醇後對冠狀動脈疾病的風險,並分析這兩種藥物與冠狀動脈疾病(CAD)發病率的劑量效應關係。

方法:

2000年-2011年台灣醫療保險研究資料庫提供的一百萬例醫療記錄。Cox比例風險比用來比較痛風病人服用別嘌呤醇或苯溴馬隆或不服用藥物對CAD疾病的風險。HR風險比調整了疾病相關的混雜因素：包括年齡、性別、高血壓、高脂血症、糖尿病、慢性腎臟疾病和相關藥物。

結果:

8047例痛風患者，1422例用單獨服用別嘌呤醇(A組)，4141例單獨服用苯溴馬隆(B組)，2484例兩種藥物聯用(A / B組)。研究結果顯示，A組、B組、A/ B組調整后冠心病的發病率無顯著差異。但是在進行劑量反應分析後發現，服用別嘌醇（400mg/d)連續治療時間超過270日，苯溴馬隆(100mg/d)連續治療時間超過360日時，可顯著降低CAD的風險。

結論:

研究結果發現苯溴馬隆單用超過360天後，與0-90天對比，冠心病發生風險減少54%（HR 0.46,95%CI, 0.34–0.60，P＜0.001）；苯溴和別嘌醇聯用超過360天後，與0-90天對比，冠心病發生風險減少56% （ HR 0.44,95%CI,0.31–0.63),P＜0.001）。在更長的使用時間上，苯溴馬隆和別嘌醇無論單用或聯用，均可降低痛風患者冠心病的發生風險，特別是在高劑量時，這種相關性更為明確。

附英文原文

Background: The effect of gout on the risk of developing coronary artery disease (CAD) is uncertain. Some studies have found that gout is a risk factor for acute myocardial infarction. This study examined the changes in risk of CAD in gout patients taking allopurinol and/or benzbromarone, and analyzed the dose-response relationship of both drugs with CAD incidence.

Methods: The medical records of one million subjects from 2000 to 2011 were provided by the Taiwan National Health Insurance Research Database. Cox proportional hazard ratio was used to compare the risk of CAD in gout patients taking allopurinol or/and benzbromarone with those taking neither drug. Hazard ratios (HR) were adjusted for possible confounding factors, including age, gender, hypertension, hyperlipidemia, diabetesmellitus, chronic kidney disease, and relevant medications.

Results: Of 8047 gout patients, 1422 were treatedwith allopurinol (Group A), 4141 with benzbromarone (Group B), and 2484 with both drugs (Group A/B) during the follow-up period. Our results showed the incidence of CAD after adjusting for covariates for Group A, Group B, and Group A/B did not significantly differ fromthe comparison group. However, after adjustment for covariates in dose-response analyses, treatment with over 270 defined daily doses (DDDs) of allopurinol, and over 360 DDDs of benzbromarone, was associated with a significantly

reduced risk of CAD.

Conclusion: We found that the use of allopurinol and benzbromarone, whether alone or in combination, had a linear dose-response relationship between the numbers of defined daily doses and the risk of CAD, especially in higher DDDs.

文章標題：Allopurinol, benzbromarone and risk of coronary heart disease in gout patients: A population-based study

作者： 高高高高

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