(1)背景:调查与视神经病变(ON)相关的危险因素,并验证以下假设:伴随使用异烟肼和其他毒性ON的原因会影响乙胺丁醇使用者ON的发展。(2)方法:这项队列研究确定了在2015年1月至2021年12月之间开始乙胺丁醇治疗并且在乙胺丁醇治疗之前没有ON的乙胺丁醇使用者。对截至2022年12月31日的ON发生率进行了评估。根据ON的存在对用户进行分组。调查人口统计学和临床特征以进行ON的危险因素分析。使用多变量逻辑回归分析计算赔率(OR)。(3)结果:在204,598名乙胺丁醇用户中,5277例(2.6%)患者在研究期间发展为ON。与没有ON的患者相比,ON患者的女性比例更高,平均年龄更高。在多变量分析中,ON和视力损害的危险因素包括性别,年龄,累积剂量,使用乙胺丁醇的肺外适应症,和全身性疾病,如糖尿病,高血压,高脂血症,糖尿病,肾病,和肝脏疾病。营养不良或营养障碍显着增加ON的风险(OR=1.27,95%置信区间[CI]=1.19-1.34),而同时使用异烟肼降低了风险(OR=0.78,95%CI=0.72-0.86).(4)结论:发现全身性疾病和营养缺乏患者的ON风险增加,而同时使用异烟肼与ON风险降低相关.有这些危险因素的患者应仔细监测,以尽量减少视力威胁。
(1) Background: To investigate the risk factors associated with optic neuropathy (ON) and validate the hypothesis that concomitant isoniazid use and other causes of toxic ON affect the development of ON in
ethambutol users. (2) Methods: This cohort study identified
ethambutol users who initiated
ethambutol therapy between January 2015 and December 2021 and had no ON prior to
ethambutol therapy. ON incidence up to 31 December 2022 was evaluated. The users were grouped on the basis of the presence of ON. Demographic and clinical characteristics were investigated for risk factor analyses of ON. Odds ratios (ORs) were calculated using multivariate logistic regression analyses. (3) Results: Among 204,598
ethambutol users, 5277 (2.6%) patients developed ON over the study period. Patients with ON included a higher percentage of women and had a higher mean age than patients without ON. In the multivariate analyses, the risk factors for ON and visual impairment included sex, age, cumulative dose, extrapulmonary indications for
ethambutol use, and systemic conditions such as diabetes, hypertension, hyperlipidemia, diabetes, kidney disease, and liver disease. Malnutrition or nutritional disorders significantly increased the risk of ON (OR = 1.27, 95% confidence interval [CI] = 1.19-1.34), whereas concomitant isoniazid use decreased the risk (OR = 0.78, 95% CI = 0.72-0.86). (4) Conclusion: An increased risk of ON in patients with systemic diseases and nutritional deficiency was identified, whereas concomitant isoniazid use was associated with a decreased risk of ON. Patients with these risk factors should be carefully monitored to minimize the vision-threatening ON.