目的:非甾体抗炎药(NSAIDs)与AKI有关。它们与肾病综合征的关系尚未得到系统研究。本研究旨在评估与使用NSAID相关的肾病综合征的风险。
方法:在英国初级保健数据库中进行了匹配的病例对照研究。病例为首次诊断为肾病综合征的患者,对照组为无肾病综合征的患者。NSAID暴露(根据环氧合酶酶选择性和化学分组进行分组)被分类为当前(在肾病综合征诊断日期和对照组的相应日期使用),最近,或过去使用。使用非条件逻辑回归分析计算赔率(OR)和95%置信区间(95%CIs)。
结果:我们包括2620例和10,454例对照。与不使用相比,目前使用15-28天和>28天的常规NSAIDs与肾病综合征的相对风险较高相关:校正OR,1.34;95%CI,1.06至1.70,OR,1.42;95%CI,分别为0.79~2.55。此外,最近使用(肾病综合征诊断日期前1-2个月停药;或,1.55;95%CI,1.11至2.15)和过去使用(停药2个月-2年;或,1.24;95%CI,1.07至1.43),但不是当前使用<15天(或,0.78;95%CI,0.46至1.31)或过去使用(停药>2年;或,0.96;95%CI,0.85至1.09)与肾病综合征的相对风险较高以及过去使用选择性COX-2抑制剂(停药2-24个月;OR,1.24;95%CI,0.98至1.58)。基于化学组的分类表明,乙酸和丙酸衍生物与肾病综合征的高风险相关。
结论:从至少2周的暴露开始,使用常规NSAIDs与肾病综合征的高风险相关,以及最近和过去接触肾病综合征前2年的诊断。这种较高的风险似乎主要归因于乙酸和丙酸衍生物。
OBJECTIVE: Nonsteroidal anti-inflammatory drugs (NSAIDs) have been associated with AKI. Their association with nephrotic syndrome has not been systematically studied. This study aimed to assess the risk of nephrotic syndrome associated with NSAID use.
METHODS: A matched case-control study was performed in the UK primary care database. Cases were patients with a first diagnosis of nephrotic syndrome and controls were those without nephrotic syndrome. NSAID exposure (grouped either based on cyclooxygenase enzyme selectivity and chemical groups) was classified as either current (use at the nephrotic syndrome diagnosis date and corresponding date in the control group), recent, or past use. Odds ratios (ORs) and 95% confidence intervals (95% CIs) were calculated using unconditional logistic regression analysis.
RESULTS: We included 2620 cases and 10,454 controls. Compared with non-use, current use of 15-28 days and >28 days of conventional NSAIDs was associated with a higher relative risk of nephrotic syndrome: adjusted OR, 1.34; 95% CI, 1.06 to 1.70, and OR, 1.42; 95% CI, 0.79 to 2.55, respectively. Also, recent use (discontinuation 1-2 months before nephrotic syndrome diagnosis date; OR, 1.55; 95% CI, 1.11 to 2.15) and past use (discontinuation 2 months-2 years; OR, 1.24; 95% CI, 1.07 to 1.43), but not current use of <15 days (OR, 0.78; 95% CI, 0.46 to 1.31) nor past use (discontinuation >2 years; OR, 0.96; 95% CI, 0.85 to 1.09) were associated with a higher relative risk of nephrotic syndrome as well as past use of selective COX-2 inhibitors (discontinuation 2-24 months; OR, 1.24; 95% CI, 0.98 to 1.58). Categorization based on chemical groups showed that acetic acid and propionic acid derivatives were associated with a higher risk of nephrotic syndrome.
CONCLUSIONS: The use of conventional NSAIDs was associated with a higher risk of nephrotic syndrome starting from at least 2 weeks of exposure, as well as for recent and past exposure up to 2 years before the diagnosis of nephrotic syndrome. This higher risk appeared mainly attributable to acetic acid and propionic acid derivatives.