经常使用阿斯匹灵与老化黄斑病变有关


  【24drs.com】经常使用阿斯匹灵和早发型老化黄斑病变(aging macula disorder,AMD)有关,也和湿性迟发型AMD有关,这些风险都与使用阿斯匹灵的频率有关。
  
  这些在线刊载于9月13日眼科学志(Ophthalmology)的研究,涵盖了近4,700名65岁以上的欧洲病患。
  
  阿姆斯特丹荷兰神经科学暨学院医学中心的Paulus T.V.M. de Jong博士等人写道,使用阿斯匹灵与AMD之间的关联已经有多所描述,但是结果并不一致。
  
  为了进一步了解这个关联,de Jong博士等人进行了一个横断面、人口基础的研究,使用结构式访谈评估使用阿斯匹灵和AMD的关联,研究对象是4,691名挪威、爱沙尼亚、英国、法国、意大利、希腊与西班牙的居民。
  
  除了询问使用阿斯匹灵的情况,也访问研究对象的社会人口统计学资料、教育程度、目前与以前的抽菸史、饮酒情况;其它问题则聚焦在医疗史,包括中风或心肌梗塞史,是否曾经诊断有心绞痛或糖尿病。
  
  使用阿斯匹灵的情况分为七类,范围从「未曾使用」到「每天使用」;也抽取空腹血液样本检测胆固醇值。
  
  之后拍摄研究对象的数码眼底影像,并送往分级中心,由2名有经验的工作人员判读;影像分级依据为「老化黄斑部病变之国际分类与分级系统」。
  
  研究人员定义干性AMD为视网膜色素上皮细胞明显缺乏明确的圆形或椭圆形区域,最大直径超过175 μm,可看见脉络膜血管,没有出现湿性AMD。
  
  湿性AMD定义为视网膜色素上皮细胞、视网膜下新血管膜出现出血型病变,视网膜下出血、视网膜周边纤维性结疤、或者并发这些特征,只要有这些特征,就算眼底影像显示为干性AMD,都必须归为湿性。
  
  作者们报告指出,36.4%的研究对象有早发型AMD,3.3%为迟发型AMD。
  
  约41%的研究对象表示每月使用阿斯匹灵,7%表示每周至少使用一次,17.3%表示每天使用。
  
  研究人员写道,对于每天使用者,校正可能的共变项之后,胜算比显示,AMD等级的严重度随之逐渐增加,校正心血管疾病或心绞痛等已知的共变项时,关联不变,不过,可能有其它未被发现的共变项。
  
  随等级相对增加的严重度分述如下:等级1为1.26 (95%信心区间[CI],1.08 - 1.46;P < .001);等级2为1.42 (95% CI,1.18 - 1.70);湿性迟发性AMD为2.22 (95% CI,1.61 - 3.05;P < .001)。
  
  作者们表示必须谨慎诠释这篇研究结果,他们指出,这是一个横断面研究,AMD患者发生视力问题后服用阿斯匹灵的可能性无法被排除。另外的研究限制是,研究对象可能说错心血管病史,导致分析错误。不过,作者们表示,希望藉由询问心脏病发作和中风等严重事件、并记录事件日期而尽量减少误报。
  
  作者们结论表示,虽然有这些研究限制,但这篇有趣的观察让我们知道必须对使用阿斯匹灵和AMD之间的关联进行后续评估。
  
  资料来源:http://www.24drs.com/professional/list/content.asp?x_logon=W&x_idno=6627&x_classno=0
  

Frequent Aspirin Use Tied to Aging Macula Disorder

By Steven Fox
Medscape Medical News

October 11, 2011 — Frequent use of aspirin is associated with early aging macula disorder (AMD), as well as wet late AMD, and risks for those problems appear to be linked to how often aspirin is consumed.

Those findings are from a study of nearly 4700 European patients aged 65 years or older that was published online September 13 in Ophthalmology.

"Associations between aspirin use and AMD have been addressed in various settings with inconsistent results," write Paulus T.V.M. de Jong, MD, PhD, from the Netherlands Institute for Neuroscience and Academic Medical Center, Amsterdam, and colleagues.

To find out more about that possible association, Dr. de Jong and colleagues conducted a cross-sectional, population-based study using structured interviews to assess aspirin use and AMD in 4691 people who lived in 7 European countries: Norway, Estonia, United Kingdom, France, Italy, Greece, and Spain.

In addition to being queried about their aspirin use, the participants were also asked about their sociodemographic status, educational level, current and past smoking history, and consumption of alcohol. Other questions focused on their medical history, including history of stroke or myocardial infarction, and whether they had been diagnosed with either angina or diabetes mellitus.

Aspirin use was gauged using a precoded response category of 7 options that ranged from "never" to "daily."

Cholesterol levels were also determined using fasting blood samples.

Digitized fundus images were then obtained from participants, and the images sent to a grading center and evaluated by 2 experienced staffers. The images were graded according to the International Classification and Grading System for Age-Related Maculopathy and AMD.

The researchers defined dry AMD as any sharply demarcated round or oval area of apparent absence of the retinal pigment epithelium, with the largest diameter more than 175 μm, with visible choroidal vessels, and with no presence of wet AMD.

Wet AMD was defined as the presence of a serous or hemorrhagic detachment of the retinal pigment epithelium, a subretinal neovascular membrane, subretinal hemorrhage, periretinal fibrous scarring, or a combination of those characteristics. That definition held even when fundus images showed patches of dry AMD.

The authors report that 36.4% of the participants had evidence of early AMD and 3.3% had evidence of late AMD.

About 41% of participants reported monthly aspirin use, 7% reported using aspirin at least once weekly, and 17.3% reported daily use.

"For daily aspirin users, the [odds ratios], adjusted for potential confounders, showed a steady increase with increasing severity of AMD grades," the researchers write. "When adjustment was made for all known confounders including [cardiovascular disease] or angina, the associations did not change. However, there may be other confounders that were not measured," they write.

Those relative increases in severity were noted as follows: grade 1, 1.26 (95% confidence interval [CI], 1.08 - 1.46; P < .001); grade 2, 1.42 (95% CI, 1.18 - 1.70); and wet late AMD, 2.22 (95% CI, 1.61 - 3.05; P < .001).

The authors advise caution in interpreting the results of the study. "This was a cross-sectional study, and the possibility that people with AMD took aspirin after experiencing visual problems cannot be excluded," they note. Another limitation is that “[i]t is possible that participants incorrectly reported their [cardiovascular disease] history, leading to residual confounding and measurement error.” However, the authors say, "[t]he protocol attempted to minimize misreporting by asking about serious events such as heart attack and stroke and also recorded the date of the event."

Even with the limitations of the study, however, the authors conclude, "[t]his interesting observation warrants further evaluation of the associations between aspirin use and AMD."

The study was supported by the European Commission Vth Framework, Brussels, Belgium. Funding for cameras was provided by the Macular Disease Society UK. Additional funding in Alicante, Spain, was provided by the Spanish Ministry of Health, Madrid, and CIBER de Epidemiologi’ y Salud Publica and the Generalitat Valenciana, both in Valencia. One author received support from the Estonian Ministry of Education and Science. The authors have disclosed no relevant financial relationships.

Ophthalmology. Published online September 13, 2011.

    
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