Abstract：
BACKGROUND: Preclinical evidence demonstrated the therapeutic potential of thiazolidinediones (TZDs) for the treatment of intracerebral hemorrhage (ICH). The present study conducted an investigation of cerebrovascular and cardiovascular outcomes following ICH in patients with type 2 diabetes mellitus (T2DM) treated with or without TZDs.
METHODS: This retrospective nested case-control study used data from the Taiwan National Health Insurance Research Database. A total of 62,515 T2DM patients who were hospitalized with a diagnosis of ICH were enrolled, including 7,603 TZD users. Data for TZD non-users were extracted using propensity score matching. Primary outcomes included death and major adverse cardiovascular events (MACEs), which were defined as a composite of ischemic stroke, hemorrhagic stroke (HS), acute myocardial infarction, and congestive heart failure. Patients aged <20 years with a history of traumatic brain injury or any prior history of MACEs were excluded.
RESULTS: TZD users had significantly lower MACE risks compared with TZD non-users following ICH (adjusted hazard ratio [aHR]: 0.90, 95% confidence interval [CI]: 0.85-0.94, p < 0.001). The most significant MACE difference reported for TZD users was HS, which possessed lower incidence than in TZD non-users, especially for the events that happened within 3 months following ICH (aHR: 0.74, 95% CI: 0.62-0.89 within 1 month, p < 0.01; aHR: 0.68, 95% CI: 0.54-0.85 between 1 and 3 month).
CONCLUSIONS: The use of TZD in patients with T2DM was associated with a lower risk of subsequent HS and mortality following ICH.
METHODS: This retrospective nested case-control study used data from the Taiwan National Health Insurance Research Database. A total of 62,515 T2DM patients who were hospitalized with a diagnosis of ICH were enrolled, including 7,603 TZD users. Data for TZD non-users were extracted using propensity score matching. Primary outcomes included death and major adverse cardiovascular events (MACEs), which were defined as a composite of ischemic stroke, hemorrhagic stroke (HS), acute myocardial infarction, and congestive heart failure. Patients aged <20 years with a history of traumatic brain injury or any prior history of MACEs were excluded.
RESULTS: TZD users had significantly lower MACE risks compared with TZD non-users following ICH (adjusted hazard ratio [aHR]: 0.90, 95% confidence interval [CI]: 0.85-0.94, p < 0.001). The most significant MACE difference reported for TZD users was HS, which possessed lower incidence than in TZD non-users, especially for the events that happened within 3 months following ICH (aHR: 0.74, 95% CI: 0.62-0.89 within 1 month, p < 0.01; aHR: 0.68, 95% CI: 0.54-0.85 between 1 and 3 month).
CONCLUSIONS: The use of TZD in patients with T2DM was associated with a lower risk of subsequent HS and mortality following ICH.
摘要：
背景：临床前证据表明TZDs治疗脑出血（ICH）的治疗潜力。本研究对接受或不接受TZDs治疗的2型糖尿病（T2DM）患者ICH后的脑血管和心血管结局进行了调查。
方法：这项回顾性嵌套病例对照研究使用台湾国民健康保险研究数据库的数据。共纳入62,515名诊断为ICH住院的T2DM患者，包括7603个TZD用户。使用倾向得分匹配提取TZD非用户的数据。主要结局包括死亡和主要不良心血管事件（MACE），它们被定义为缺血性中风的复合物，出血性中风（HS），急性心肌梗死(AMI),充血性心力衰竭（CHF）。年龄<20岁、有创伤性脑损伤史或任何之前的MACEs病史的患者被排除在外。
结果：TZD使用者与非TZD使用者相比，ICH后的MACE风险显著降低（校正风险比[aHR]：0.90，95%置信区间[CI]：0.85-0.94，p<0.001）。TZD用户报告的最显著的MACE差异是HS，发病率低于TZD非使用者，特别是对于ICH后3个月内发生的事件(aHR：0.74，95%CI：0.62-0.89，一个月内，p<0.01；aHR：0.68，95％CI：1-3个月之间0.54-0.85）。
结论：T2DM患者使用TZD与较低的继发HS风险和ICH后死亡率相关。
方法：这项回顾性嵌套病例对照研究使用台湾国民健康保险研究数据库的数据。共纳入62,515名诊断为ICH住院的T2DM患者，包括7603个TZD用户。使用倾向得分匹配提取TZD非用户的数据。主要结局包括死亡和主要不良心血管事件（MACE），它们被定义为缺血性中风的复合物，出血性中风（HS），急性心肌梗死(AMI),充血性心力衰竭（CHF）。年龄<20岁、有创伤性脑损伤史或任何之前的MACEs病史的患者被排除在外。
结果：TZD使用者与非TZD使用者相比，ICH后的MACE风险显著降低（校正风险比[aHR]：0.90，95%置信区间[CI]：0.85-0.94，p<0.001）。TZD用户报告的最显著的MACE差异是HS，发病率低于TZD非使用者，特别是对于ICH后3个月内发生的事件(aHR：0.74，95%CI：0.62-0.89，一个月内，p<0.01；aHR：0.68，95％CI：1-3个月之间0.54-0.85）。
结论：T2DM患者使用TZD与较低的继发HS风险和ICH后死亡率相关。
