Low-dose aspirin

低剂量阿司匹林
  • 文章类型: Journal Article
    背景:睡眠不足,如表现为睡眠时间短或失眠症状,已知会增加涉及免疫病理学的多种疾病的风险。据推测,炎症是睡眠不足作为这些疾病的危险因素的一种机制。因此,减轻与睡眠不足相关的负面健康后果的一个潜在方法是靶向炎症。很少有干预性睡眠研究调查改善睡眠是否会影响炎症过程。但结果表明,补充方法可能需要针对与睡眠不足相关的炎症。我们调查了是否通过低剂量乙酰水杨酸靶向炎症(ASA,即,阿司匹林)能够减弱实验性睡眠限制的炎症反应。
    方法:46名健康参与者(19F/27M,年龄范围19-63岁)在一项双盲随机安慰剂对照交叉试验中进行了研究,每个方案包括14天的家庭监测阶段,然后是11天(10晚)实验室停留(睡眠限制/ASA,睡眠限制/安慰剂,控制睡眠/安慰剂)。在睡眠限制/ASA条件下,参与者在家庭阶段和随后的实验室停留期间,在晚上(22:00)每日服用低剂量ASA(81mg/天).在睡眠限制/安慰剂和对照睡眠/安慰剂条件下,参与者每天服用安慰剂.每次实验室停留从2晚开始,睡眠机会为8小时/晚(23:00-07:00),用于适应和基线测量。在两种睡眠限制条件下,参与者暴露于5个晚上的睡眠,限制睡眠时间为4小时/夜(03:00-07:00),随后是3个晚上的恢复睡眠,睡眠时间为8小时/夜.在控制睡眠条件下,在整个实验室逗留期间,参与者的睡眠机会为8小时/晚.在每次实验室逗留期间,参与者进行了3天的强化监测(基线时,第5天睡眠限制/控制睡眠,和恢复睡眠的第二天)。变量,包括促炎免疫细胞功能,C反应蛋白(CRP),和活动图估计的睡眠测量,使用广义线性混合模型进行分析。
    结果:低剂量ASA给药降低了LPS刺激的单核细胞中白细胞介素(IL)-6的表达(对于条件*天,p<0.05),并降低了血清CRP水平(对于条件为p<0.01)与睡眠限制条件下的安慰剂给药相比,在5个晚上的睡眠限制后。与安慰剂相比,低剂量ASA还减少了5晚睡眠限制后2晚恢复睡眠后LPS刺激的单核细胞中环氧合酶(COX)-1/COX-2双阳性细胞的量(p<0.05条件)。低剂量ASA在恢复睡眠的前2个晚上进一步降低了睡眠开始后的觉醒(WASO)并增加了睡眠效率(SE)(对于条件和条件*日,p<0.001)。基线比较显示所有研究变量的条件之间没有差异(条件p>0.05)。
    结论:这项研究表明,预先给予低剂量ASA可以减少对睡眠限制的炎症反应。这一发现可能为预防或控制炎症及其在睡眠不足患者中的后果开辟了新的治疗方法。
    背景:ClinicalTrials.govNCT03377543。
    BACKGROUND: Sleep deficiencies, such as manifested in short sleep duration or insomnia symptoms, are known to increase the risk for multiple disease conditions involving immunopathology. Inflammation is hypothesized to be a mechanism through which deficient sleep acts as a risk factor for these conditions. Thus, one potential way to mitigate negative health consequences associated with deficient sleep is to target inflammation. Few interventional sleep studies investigated whether improving sleep affects inflammatory processes, but results suggest that complementary approaches may be necessary to target inflammation associated with sleep deficiencies. We investigated whether targeting inflammation through low-dose acetylsalicylic acid (ASA, i.e., aspirin) is able to blunt the inflammatory response to experimental sleep restriction.
    METHODS: 46 healthy participants (19F/27M, age range 19-63 years) were studied in a double-blind randomized placebo-controlled crossover trial with three protocols each consisting of a 14-day at-home monitoring phase followed by an 11-day (10-night) in-laboratory stay (sleep restriction/ASA, sleep restriction/placebo, control sleep/placebo). In the sleep restriction/ASA condition, participants took low-dose ASA (81 mg/day) daily in the evening (22:00) during the at-home phase and the subsequent in-laboratory stay. In the sleep restriction/placebo and control sleep/placebo conditions, participants took placebo daily. Each in-laboratory stay started with 2 nights with a sleep opportunity of 8 h/night (23:00-07:00) for adaptation and baseline measurements. Under the two sleep restriction conditions, participants were exposed to 5 nights of sleep restricted to a sleep opportunity of 4 h/night (03:00-07:00) followed by 3 nights of recovery sleep with a sleep opportunity of 8 h/night. Under the control sleep condition, participants had a sleep opportunity of 8 h/night throughout the in-laboratory stay. During each in-laboratory stay, participants had 3 days of intensive monitoring (at baseline, 5th day of sleep restriction/control sleep, and 2nd day of recovery sleep). Variables, including pro-inflammatory immune cell function, C-reactive protein (CRP), and actigraphy-estimated measures of sleep, were analyzed using generalized linear mixed models.
    RESULTS: Low-dose ASA administration reduced the interleukin (IL)-6 expression in LPS-stimulated monocytes (p<0.05 for condition*day) and reduced serum CRP levels (p<0.01 for condition) after 5 nights of sleep restriction compared to placebo administration in the sleep restriction condition. Low-dose ASA also reduced the amount of cyclooxygenase (COX)-1/COX-2 double positive cells among LPS-stimulated monocytes after 2 nights of recovery sleep following 5 nights of sleep restriction compared to placebo (p<0.05 for condition). Low-dose ASA further decreased wake after sleep onset (WASO) and increased sleep efficiency (SE) during the first 2 nights of recovery sleep (p<0.001 for condition and condition*day). Baseline comparisons revealed no differences between conditions for all of the investigated variables (p>0.05 for condition).
    CONCLUSIONS: This study shows that inflammatory responses to sleep restriction can be reduced by preemptive administration of low-dose ASA. This finding may open new therapeutic approaches to prevent or control inflammation and its consequences in those experiencing sleep deficiencies.
    BACKGROUND: ClinicalTrials.gov NCT03377543.
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  • 文章类型: Journal Article
    背景:质子泵抑制剂(PPI)可预防阿司匹林相关的胃和十二指肠粘膜损伤。然而,长期使用PPI会导致各种不良反应,如胃息肉和肠嗜铬细胞样增生。目前研究表明,上述不良反应主要与高胃泌素血症有关。我们研究了奥美拉唑的低频给药是否可以有效修复阿司匹林引起的粘膜损伤并降低长期使用PPI相关的胃泌素水平的升高。
    方法:Sprague-Dawley大鼠分为4个治疗组:每日服用阿司匹林,每日阿司匹林和奥美拉唑每天一次(qd),每日阿司匹林和奥美拉唑每隔一天一次(qod),每日阿司匹林和奥美拉唑每三天一次(1/d3)。喂食15天后,收集血样,处死大鼠的胃进行宏观观察,组织学,和免疫组织化学研究。此外,在临床实践中,阿司匹林引起的消化性溃疡患者每隔一天服用一次标准剂量的奥美拉唑(20mg).两个月后,进行胃镜检查以检查溃疡的愈合情况。
    结果:奥美拉唑qd和奥美拉唑qod给药都能有效预防阿司匹林引起的胃溃疡,两组在抑制壁细胞分泌胃酸和细胞凋亡方面无显著差异。然而,奥美拉唑1/d3不能完全预防阿司匹林引起的胃粘膜损伤。值得注意的是,胃泌素水平,奥美拉唑qd组的细胞增殖能力和胆囊收缩素B受体表达明显高于奥美拉唑qod组。在临床工作中,由阿司匹林引起的消化性溃疡患者每隔一天给予标准剂量的奥美拉唑,两个月后他们的溃疡就痊愈了,如胃镜观察。
    结论:奥美拉唑隔日一次可有效预防阿司匹林引起的消化性溃疡,降低高胃泌素血症,这可能会减少PPI治疗的长期不良反应。
    BACKGROUND: Proton-pump inhibitors (PPIs) prevent aspirin-associated gastric and duodenal mucosal damage. However, long-term use of PPIs can lead to various adverse reactions, such as gastric polyps and enterochromaffin-like cell hyperplasia. Current research indicates that the abovementioned adverse reactions are mainly related to hypergastrinemia. We investigated whether low-frequency administration of omeprazole could effectively repair aspirin-induced mucosal damage and reduce the increase in gastrin levels associated with long-term use of PPIs.
    METHODS: Sprague‒Dawley rats were divided into four treatment groups: daily aspirin, daily aspirin and omeprazole once every day (qd), daily aspirin and omeprazole once every other day (qod), and daily aspirin and omeprazole once every three days (1/d3). After 15 days of feeding, blood samples were collected, and the stomachs of sacrificed rats were subjected to macroscopic, histological, and immunohistochemical studies. Moreover, in clinical practice, patients with peptic ulcers caused by aspirin took a standard dose of omeprazole (20 mg) every other day. Two months later, gastroscopy was performed to examine the healing of the ulcers.
    RESULTS: Both the omeprazole qd and omeprazole qod administrations effectively prevented aspirin-induced gastric peptic ulcers, with no significant difference between the two groups in the inhibition of parietal cell secretion of gastric acid and cell apoptosis. However, omeprazole 1/d3 failed to completely prevent aspirin-induced gastric mucosal injury. Notably, the gastrin levels, cell proliferation ability and cholecystokinin B receptor expression of the omeprazole qd group were significantly higher than those of the omeprazole qod group. In clinical work, patients with peptic ulcers caused by aspirin were given a standard dose of omeprazole every other day, and their ulcers healed after 2 months, as observed by gastroscopy.
    CONCLUSIONS: Omeprazole administration once every other day can effectively prevent aspirin-induced peptic ulcers and reduce hypergastrinemia, which may reduce the long-term adverse effects of PPI treatment.
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  • 文章类型: Journal Article
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  • 文章类型: Journal Article
    先兆子痫是一种综合征,仍然是孕产妇和新生儿死亡的主要原因,特别是在低收入国家。低剂量阿司匹林可降低先兆子痫的风险,但机制仍然未知。确定先兆子痫风险妇女的危险因素是基于临床特征。被确定为高风险的妇女将受益于开始的阿司匹林治疗,最好在孕早期结束。目前的努力主要集中在开发结合临床风险因素的筛查算法上,母体生物标志物,在妊娠早期进行子宫动脉多普勒评估。然而,大多数关于先兆子痫的研究是在高收入环境中进行的,增加了获得的信息是否可以完全应用于低资源环境的不确定性。在低收入和中等收入国家,缺乏足够的产前护理和产前护理就诊的延迟为筛查先兆子痫和开始阿司匹林治疗带来了重大挑战.此外,基于算法的孕早期筛查和随后的阿司匹林治疗的预防效果主要是针对早产先兆子痫,和综述表明对降低足月先兆子痫风险的影响很小或没有影响。缺乏关于阿司匹林预防足月先兆子痫的有效性的证据是一个至关重要的问题,因为75%的女性会发展成这种亚型的综合征。关于不良后果,低剂量阿司匹林可能与产后出血的高风险有关,在许多低收入和中等收入国家,这种疾病与先兆子痫一样致命。在讨论哪些孕妇将从使用阿司匹林和预防先兆子痫的理想阿司匹林剂量中受益时,应考虑低收入环境中妇女产后出血的风险增加。此外,妇女在怀孕期间坚持服用阿司匹林对于确定其有效性和并发症至关重要,在试验中经常被忽视的一个方面。在这次审查中,我们分析了在低收入和中等收入国家安全增加低剂量阿司匹林使用必须解决的知识差距,并提出了未来研究的方向。
    Preeclampsia is a syndrome that continues to be a major contributor to maternal and neonatal mortality, especially in low-income countries. Low-dose aspirin reduces the risk of preeclampsia, but the mechanism is still unknown. Risk factors to identify women at risk of preeclampsia are based on clinical characteristics. Women identified as high-risk would benefit from aspirin treatment initiated, preferably at the end of the first trimester. Current efforts have largely focused on developing screening algorithms that incorporate clinical risk factors, maternal biomarkers, and uterine artery Doppler evaluated in the first trimester. However, most studies on preeclampsia are conducted in high-income settings, raising uncertainties about whether the information gained can be totally applied in low-resource settings. In low- and middle-income countries, lack of adequate antenatal care and late commencement of antenatal care visits pose significant challenges for both screening for preeclampsia and initiating aspirin treatment. Furthermore, the preventive effect of first-trimester screening based on algorithms and subsequent aspirin treatment is primarily seen for preterm preeclampsia, and reviews indicate minimal or no impact on reducing the risk of term preeclampsia. The lack of evidence regarding the effectiveness of aspirin in preventing term preeclampsia is a crucial concern, as 75% of women will develop this subtype of the syndrome. Regarding adverse outcomes, low-dose aspirin has been linked to a possible higher risk of postpartum hemorrhage, a condition as deadly as preeclampsia in many low- and middle-income countries. The increased risk of postpartum hemorrhage among women in low-income settings should be taken into consideration when discussing which pregnant women would benefit from the use of aspirin and the ideal aspirin dosage for preventing preeclampsia. In addition, women\'s adherence to aspirin during pregnancy is crucial for determining its effectiveness and complications, an aspect often overlooked in trials. In this review, we analyze the knowledge gaps that must be addressed to safely increase low-dose aspirin use in low- and middle-income countries, and we propose directions for future research.
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  • 文章类型: Journal Article
    本研究旨在探讨复发性子痫前期(rPE)的临床特征,并评估低剂量阿司匹林(LDA)在rPE中的预防作用。我们回顾性分析了2016年1月至2022年12月在北京大学第一医院连续两次妊娠并分娩的109例子痫前期患者的资料。我们分析了rPE患者的妊娠结局,并评估了妊娠期间使用LDA是否可以改善这些结局。我们的结果显示,与首次发作先兆子痫相比,rPE患者在怀孕期间的体重指数(BMI)更高,糖尿病发生率更高(29.01±4.70kg/m2vs.27.13±4.25kg/m2,P<0.05;11.01%vs.1.83%,P<0.05)。此外,rPE患者复发时重度先兆子痫的发生率高于首次发病(83.49%vs.70.64%,P<0.05),以及重度子痫前期伴慢性高血压的发病率(34.86%vs.8.26%,P<0.05)。此外,rPE患者的妊娠期糖尿病和产后出血的发生率高于首次先兆子痫(25.69%vs.5.50%,P<0.05;20.18%vs.5.83%,P<0.05)。与第一次先兆子痫相比,rPE患者分娩时孕龄较早(35.42±3.06周vs.36.60±2.74周,P<0.05),新生儿出生体重较低(2478.39±828.44gvs.2883.71±712.94g,P<0.05),早产的风险更高(67.00%vs.47.19%,P<0.05)。然而,在rPE患者中,LDA的使用延迟了分娩时的胎龄,增加了新生儿的出生体重,降低了早产率,提高了围产期存活率。总之,rPE患者发生不良母婴结局的风险增加.然而,妊娠期使用LDA可有效改善这些结局.
    Our study aimed to investigate the clinical features of recurrent preeclampsia (rPE) and evaluate the preventive effect of low-dose aspirin (LDA) in rPE. We retrospectively analyzed the data of 109 patients who experienced preeclampsia in two consecutive pregnancies and delivered at Peking University First Hospital from January 2016 to December 2022. We analyzed the pregnancy outcomes of patients with rPE and assessed whether the use of LDA during pregnancy could improve these outcomes. Our results revealed that patients with rPE had a higher body mass index (BMI) and a higher incidence of diabetes during pregnancy compared to their first onset of preeclampsia (29.01 ± 4.70 kg/m2 vs. 27.13 ± 4.25 kg/m2, P < 0.05; 11.01% vs. 1.83%, P < 0.05). Furthermore, the incidence of severe preeclampsia was higher at recurrence in patients with rPE compared to their first onset (83.49% vs. 70.64%, P < 0.05), as well as the incidence of severe preeclampsia with chronic hypertension (34.86% vs. 8.26%, P < 0.05). Additionally, the incidence of gestational diabetes and postpartum hemorrhage was higher in patients with rPE compared to their first preeclampsia onset (25.69% vs. 5.50%, P < 0.05; 20.18% vs. 5.83%, P < 0.05). Compared to the first onset of preeclampsia, patients with rPE had an earlier gestational age at delivery (35.42 ± 3.06 weeks vs. 36.60 ± 2.74 weeks, P < 0.05), lower birth weight of neonates (2478.39 ± 828.44 g vs. 2883.71 ± 712.94 g, P < 0.05), and a higher risk of premature birth (67.00% vs. 47.19%, P < 0.05). However, in patients with rPE, the use of LDA delayed the gestational age at delivery, increased the birth weight of the neonate, reduced the premature birth rate, and increased the perinatal survival rate. In conclusion, patients with rPE are at an increased risk of adverse maternal and fetal outcomes. However, the use of LDA during pregnancy effectively improves these outcomes.
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  • 文章类型: Meta-Analysis
    目的:系统评价低分子肝素(LMWH)预防无血栓形成高危孕妇子痫前期的疗效。
    方法:PubMed,使用组合关键词“先兆子痫”搜索Embase和Cochrane图书馆在2022年8月1日之前发表的文章,“低分子量肝素”,\"LMWH\",\"肝素,低分子量\",\"达肝素\",\"Nadroparin\",和“Tinzaparin”。
    方法:评价LMWH在无血栓形成倾向的先兆子痫高危孕妇中的应用的随机对照试验。
    方法:10项研究纳入荟萃分析(共1758例患者)。结果表示为具有95%置信区间(CI)的相对风险(RR)。
    结果:LMWH降低了无血栓形成的高危孕妇的PE发生率(RR=0.67;95%CI=0.50-0.90;P=0.009)。亚组分析发现,仅在使用低剂量阿司匹林(LDA)作为主要干预措施的研究中,LMWH的预防作用才显着。LMWH和LDA的组合对于预防早产和胎儿生长受限也是有效的,但对胎盘早剥的发生率没有影响。
    结论:对于患有先兆子痫而无血栓形成的高风险女性,LMWH和低剂量阿司匹林的组合对于预防先兆子痫是有效的,早产和胎儿生长受限,优于单独的LDA。
    OBJECTIVE: To systematically evaluate the efficacy of low molecular weight heparin (LMWH) to prevent preeclampsia in high risk pregnant women without thrombophilia.
    METHODS: PubMed, Embase and the Cochrane library were searched for articles published before 1st August 2022 using the combination keywords \"preeclampsia\", \"Low Molecular Weight Heparin\", \"LMWH\", \"Heparin, Low Molecular Weight\", \"Dalteparin\", \"Nadroparin\", and \"Tinzaparin\".
    METHODS: Randomized controlled trials evaluating the use of LMWH in pregnant women at high risk of preeclampsia without thrombophilia.
    METHODS: Ten studies were included in the meta-analysis (1758 patients in total). Outcomes were expressed as relative risk (RR) with 95% confidence intervals (CI).
    RESULTS: LMWH reduced the incidence of PE (RR = 0.67; 95% CI = 0.50-0.90; P = 0.009) in high risk pregnant women without thrombophilia. Subgroup analysis found that the prophylactic effect of LMWH was only significant in studies using low-dose aspirin (LDA) as the primary intervention. The combination of LMWH and LDA was also effective for the prevention of preterm birth and fetal growth restriction, but had no effect on the incidence of placenta abruption.
    CONCLUSIONS: For women at high risk of developing preeclampsia without thrombophilia, the combination of LMWH and low-dose aspirin is effective for the prevention of preeclampsia, preterm birth and fetal growth restriction and is superior to LDA alone.
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  • 文章类型: Journal Article
    背景:早产是围产期发病率和死亡率的主要原因。美国早产率存在显著的种族差异,黑人的风险比白人高得多。尽管目前正在研究低剂量阿司匹林以降低早产率,关于低剂量阿司匹林的使用如何影响早产率的种族和族裔差异的数据有限.
    目的:我们的研究小组和其他研究表明,低剂量阿司匹林可降低低危产妇的自发性早产。这项研究旨在研究低剂量阿司匹林与自发性早产风险之间的关系是否因种族和种族而改变。
    方法:这是一项随机临床试验的二级分析,该试验检查了低剂量阿司匹林在低风险未产个体中预防先兆子痫的作用。母体试验将低风险定义为没有预先存在的高血压或其他医学合并症。参与者在妊娠13至25周之间接受60毫克阿司匹林或安慰剂。这里,多胎妊娠,胎儿畸形,妊娠<20周时终止妊娠或流产,既往流产的参与者被排除在外.我们的曝光,种族和民族,在父母试验中自我报告,并归类为非西班牙裔白人,西班牙裔,非西班牙裔黑人,和其他。主要结局是妊娠<34周时的自发性早产;次要结局包括妊娠<37周时的自发性早产和妊娠<34周和<37周时的所有早产。Fitlogistic回归模型用于检查低剂量阿司匹林的使用如何改变种族和民族与早产之间的关系。适应混杂因素。此外,我们进行了敏感性分析,以按种族和民族比较早产率.
    结果:值得注意的是,3171名父母研究参与者中的2528人被纳入本分析。在参与者中,425名(16.8%)为白人,819人(32.4%)是西班牙裔,1265(50%)是黑人,19人(0.8%)为其他。种族和族裔群体的基线特征不同,包括产妇年龄,身体质量指数,教育水平,婚姻状况,烟草和酒精的使用,怀孕的损失。妊娠<34周时自发早产率黑人参与者(2.8%)明显高于白人(1.2%)和西班牙裔(1.2%)参与者(P=.04)。Logistic回归分析显示,在控制低剂量阿司匹林时,在<34孕周,黑人种族不再是自发早产的独立危险因素(调整后的比值比,1.71;95%置信区间,0.67-4.40)。对于妊娠<37周的自发早产和妊娠<34和<37周的早产也发现了类似的模式。在我们的敏感性分析中,妊娠<34周时自发性早产在安慰剂组的种族和民族方面存在差异(P=.01),但在低剂量阿司匹林组没有差异(P=.90).
    结论:在妊娠34周时,低剂量阿司匹林的使用减轻了自发性早产的种族差异。需要进行额外的调查以评估我们发现的可重复性。
    BACKGROUND: Preterm birth is a leading cause of perinatal morbidity and mortality. There are significant racial disparities in the rates of preterm delivery in the United States, with Black individuals at disproportionately higher risk than their White counterparts. Although low-dose aspirin is currently under investigation for reducing the rates of preterm delivery, limited data are available on how the use of low-dose aspirin might affect racial and ethnic disparities in the rates of preterm delivery.
    OBJECTIVE: Our group and others have shown that low-dose aspirin decreases spontaneous preterm delivery in low-risk parturients. This study aimed to examine whether the relationship between low-dose aspirin and the risk of spontaneous preterm delivery is modified by race and ethnicity.
    METHODS: This was a secondary analysis of a randomized clinical trial examining low-dose aspirin for preeclampsia prevention in low-risk nulliparous individuals. The parent trial defined low risk as the absence of preexisting hypertension or other medical comorbidities. Participants received 60-mg aspirin or placebo between 13 and 25 weeks of gestation. Here, multiple pregnancies, fetal anomalies, terminations or abortions at <20 weeks of gestation, and participants with previous miscarriages were excluded. Our exposure, race and ethnicity, was self-reported in the parent trial and categorized as non-Hispanic White, Hispanic, non-Hispanic Black, and other. The primary outcome was spontaneous preterm delivery at <34 weeks of gestation; the secondary outcomes included spontaneous preterm delivery at <37 weeks of gestation and all preterm deliveries at <34 and <37 weeks of gestation. Fit logistic regression models were used to examine how the use of low-dose aspirin modified the relationship between race and ethnicity and preterm delivery, adjusting for confounders. Furthermore, sensitivity analyses were performed to compare the rates of preterm delivery by race and ethnicity.
    RESULTS: Of note, 2528 of 3171 parent study participants were included in this analysis. Of the participants, 425 (16.8%) were White, 819 (32.4%) were Hispanic, 1265 (50%) were Black, and 19 (0.8%) were other. The baseline characteristics differed among racial and ethnic groups, including maternal age, body mass index, education level, marital status, tobacco and alcohol use, and pregnancy loss. The rate of spontaneous preterm delivery at <34 weeks of gestation was significantly higher in Black participants (2.8%) than in White (1.2%) and Hispanic (1.2%) participants (P=.04). Logistical regression analysis showed that Black race was no longer an independent risk factor for spontaneous preterm delivery at <34 weeks of gestation when controlling for low-dose aspirin (adjusted odds ratio, 1.71; 95% confidence interval, 0.67-4.40). A similar pattern was found for spontaneous preterm delivery at <37 weeks of gestation and preterm delivery at <34 and <37 weeks of gestation. In our sensitivity analyses, spontaneous preterm delivery at <34 weeks of gestation differed by race and ethnicity in the placebo group (P=.01) but did not differ in the low-dose aspirin group (P=.90).
    CONCLUSIONS: The use of low-dose aspirin mitigated racial disparities in spontaneous preterm delivery at <34 weeks of gestation. Additional investigation is warranted to assess the reproducibility of our findings.
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  • 文章类型: Journal Article
    我们的目标是通过使用基于蛋白质组学的母体血清筛查测试以及治疗干预措施来评估妊娠是否延长。这是PREVENT-PTB随机试验的次要分析,比较了使用PreTRM测试进行筛选与不进行筛选的情况。初步试验分析发现,早产率在组间没有显着差异。与其考虑二分法的结果(早产与足月),我们使用生存分析将出生时的胎龄作为连续变量.我们还评估了NICU住院时间和呼吸支持持续时间的组间差异。结果表明,与对照组相比,使用PreTRM测试筛选的受试者的妊娠显着延长(调整后的风险比0.53,95%置信区间0.36-0.78,p<0.01)。筛查对象的新生儿NICU停留时间明显缩短,但呼吸支持持续时间没有显着减少。在PreTRM筛查阳性组中,与妊娠延长相关的干预措施包括护理管理和低剂量阿司匹林,但不包括己酸17-羟孕酮.我们得出的结论是,使用PreTRM测试进行筛查,然后对筛查阳性的妊娠进行干预可能会延长妊娠并降低NICULOS。但这些观察结果需要进一步的研究证实。
    Our objective was to evaluate whether pregnancy is prolonged by the use of a proteomics-based maternal serum screening test followed by treatment interventions. This is a secondary analysis of the PREVENT-PTB randomized trial comparing screening with the PreTRM test versus no screening. The primary trial analysis found no significant between-group difference in the preterm birth rate. Rather than considering a dichotomous outcome (preterm versus term), we treated gestational age at birth as a continuous variable using survival analysis. We also evaluated between-group difference in NICU length of stay and duration of respiratory support. Results indicated that pregnancy was significantly prolonged in subjects screened with the PreTRM test compared to controls (adjusted hazard ratio 0.53, 95% confidence interval 0.36-0.78, p < 0.01). Newborns of screened subjects had significantly shorter NICU stays but no significant decrease in duration of respiratory support. In the PreTRM screen-positive group, interventions that were associated with pregnancy prolongation included care management and low-dose aspirin but not 17-hydroxyprogesterone caproate. We conclude that screening with the PreTRM test followed by interventions for screen-positive pregnancies may prolong pregnancy and reduce NICU LOS, but these observations need to be confirmed by additional research.
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  • 文章类型: Multicenter Study
    目的:低剂量阿司匹林已被证明可以降低早产先兆子痫的风险,并且建议应推荐用于所有妊娠。然而,一些研究报道了低剂量阿司匹林与妊娠期出血并发症风险增加之间的关联.我们的目的是评估医护人员推荐预防性阿司匹林的患者胎盘早剥和产后出血(PPH)的风险。
    方法:这项多中心队列研究包括美国19家医院(2019年1月至2021年12月)的72,598例单胎分娩。妊娠合并前置胎盘/植入,出生在妊娠不到24周,多胎妊娠,或阿司匹林推荐的缺失数据被排除.使用跨越社会人口统计学因素的20个特征计算倾向得分,病史,Year,医院提供护理。低剂量阿司匹林推荐与胎盘早剥或产后出血之间的关联使用倾向评分通过逆概率加权来估计。
    结果:我们在最终分析中纳入了71,627例妊娠。阿司匹林被推荐使用6,677(9.3%),更有可能被推荐用于年龄较大的孕妇(p<0.001)。体重指数(BMI)较高(p<0.001),有孕前高血压(p<0.001),并且没有自然阴道分娩(p<0.001)。总的来说,研究队列中有1,205例(1.7%)发生了早产先兆子痫:无阿司匹林组为1.3%,阿司匹林组为5.7%。在用倾向得分进行逆概率加权后,阿司匹林与胎盘早剥(校正OR1.44;95%CI1.04,2.00)和产后出血(校正OR1.21;95%CI1.05,1.39)的风险增加相关.使用低剂量阿司匹林所需的伤害数量为产后出血的79分之一(95%CI1/43,1/330)和胎盘早剥的287分之一(95%CI1/127,1/3151)。
    结论:妊娠期推荐低剂量阿司匹林与胎盘早剥和产后出血风险增加相关。我们的研究结果支持需要对阿司匹林和妊娠出血并发症进行更多的研究,然后再推荐超过最高风险的妊娠。本文受版权保护。保留所有权利。
    Low-dose aspirin (LDA) has been shown to reduce the risk of preterm pre-eclampsia and it has been suggested that it should be recommended for all pregnancies. However, some studies have reported an association between LDA and an increased risk of bleeding complications in pregnancy. Our aim was to evaluate the risk of placental abruption and postpartum hemorrhage (PPH) in patients for whom their healthcare provider had recommended prophylactic aspirin.
    This multicenter cohort study included 72 598 singleton births at 19 hospitals in the USA, between January 2019 and December 2021. Pregnancies complicated by placenta previa/accreta, birth occurring at less than 24 weeks\' gestation, multiple pregnancy or those with data missing for aspirin recommendation were excluded. Propensity scores were calculated using 20 features spanning sociodemographic factors, medical history, year and hospital providing care. The association between LDA recommendation and placental abruption or PPH was estimated by inverse-probability treatment weighting using the propensity scores.
    We included 71 627 pregnancies in the final analysis. Aspirin was recommended to 6677 (9.3%) and was more likely to be recommended for pregnant individuals who were 35 years or older (P < 0.001), had a body mass index of 30 kg/m2 or higher (P < 0.001), had prepregnancy hypertension (P < 0.001) and who had a Cesarean delivery (P < 0.001). Overall, 1.7% of the study cohort (1205 pregnancies) developed preterm pre-eclampsia: 1.3% in the no-aspirin and 5.8% in the aspirin group. After inverse-probability weighting with propensity scores, aspirin was associated with increased risk of placental abruption (adjusted odds ratio (aOR), 1.44 (95% CI, 1.04-2.00)) and PPH (aOR, 1.21 (95% CI, 1.05-1.39)). The aOR translated to a number needed to harm with LDA of 79 (95% CI, 43-330) for PPH and 287 (95% CI, 127-3151) for placental abruption.
    LDA recommendation in pregnancy was associated with increased risk for placental abruption and for PPH. Our results support the need for more research into aspirin use and bleeding complications in pregnancy before recommending it beyond the highest-risk pregnancies. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
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  • 文章类型: Journal Article
    背景:先前的研究评估了阿司匹林的预后效果,他汀类药物,和二甲双胍在乳腺癌(BC)患者中,结果不确定。
    方法:我们进行了一项全国性的基于人群的队列研究,以评估诊断后是否使用低剂量阿司匹林,他汀类药物,二甲双胍与BC特异性生存率相关。年龄≥50岁并在2004-2017年诊断为BC的女性,诊断后存活≥12个月(诊断后12个月开始随访),在挪威癌症登记处发现。挪威处方数据库提供了有关处方的信息。多变量Cox比例风险模型用于估计诊断后使用与BC特异性生存之间的关联的风险比(HR)和95%置信区间(CI)。总体和雌激素受体(ER)状态。
    结果:共纳入26,190例患者。其中,5324(20%),7591(29%),1495(6%)是低剂量阿司匹林的诊断后使用者,他汀类药物,还有二甲双胍,分别。中位随访时间为6.1年,2169例(8%)患者死于BC。供使用的HR,与没有使用相比,低剂量阿司匹林的估计为0.96(95%CI0.85-1.08)(ER:HR=0.97,95%CI0.83-1.13;ER-:HR=0.97,95%CI0.73-1.29,相互作用的p值=0.562),他汀类药物为0.84(95%CI0.75-0.94)(ER:HR=0.95,95%CI0.82-1.09;ER-:HR=0.77,95%CI0.60-1.00,相互作用的p值=0.259),二甲双胍和0.70(95%CI0.51-0.96)(与使用非二甲双胍抗糖尿病药物相比)(ER:HR=0.67,95%CI0.45-1.01;ER-:HR=1.62,95%CI0.72-3.62,相互作用的p值=0.077)。
    结论:我们发现有证据支持他汀类药物和二甲双胍的诊断后使用与生存率之间的关联。在BC患者中。我们的发现表明了根据ER状态的潜在差异。
    Previous studies assessed the prognostic effect of aspirin, statins, and metformin in breast cancer (BC) patients, with inconclusive results.
    We performed a nationwide population-based cohort study to evaluate if post-diagnostic use of low-dose aspirin, statins, and metformin was associated with BC-specific survival. Women aged ≥ 50 years and diagnosed with BC in 2004-2017, who survived ≥ 12 months after diagnosis (follow-up started 12 months after diagnosis), were identified in the Cancer Registry of Norway. The Norwegian Prescription Database provided information on prescriptions. Multivariable Cox proportional hazard models were used to estimate hazard ratios (HR) and 95% confidence intervals (CI) for the association between post-diagnostic use and BC-specific survival, overall and by oestrogen receptor (ER) status.
    A total of 26,190 patients were included. Of these, 5324 (20%), 7591 (29%), and 1495 (6%) were post-diagnostic users of low-dose aspirin, statins, and metformin, respectively. The median follow-up was 6.1 years, and 2169 (8%) patients died from BC. HRs for use, compared to no use, were estimated at 0.96 (95% CI 0.85-1.08) for low-dose aspirin (ER+: HR = 0.97, 95% CI 0.83-1.13; ER-: HR = 0.97, 95% CI 0.73-1.29, p value for interaction = 0.562), 0.84 (95% CI 0.75-0.94) for statins (ER+: HR = 0.95, 95% CI 0.82-1.09; ER-: HR = 0.77, 95% CI 0.60-1.00, p value for interaction = 0.259), and 0.70 (95% CI 0.51-0.96) for metformin (compared to use of non-metformin antidiabetics) (ER+: HR = 0.67, 95% CI 0.45-1.01; ER-: HR = 1.62, 95% CI 0.72-3.62, p value for interaction = 0.077).
    We found evidence supporting an association between post-diagnostic use of statins and metformin and survival, in patients with BC. Our findings indicate potential differences according to ER status.
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