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摘要

目的：为了评估使用别嘌呤醇对中老年人发生房颤事件风险的影响。

方法：我们选用了从2006年到2012年医疗保险数据中5%的随机事件进行调查，从而分析使用别嘌呤醇与在基线状态下无房颤的患者发生房颤事件的关系（至少365天）。多变量调整后回归分析将别嘌呤醇暴露时间和别嘌呤醇非暴露时间对房颤的风险加以比较，控制了年龄、性别、种族、察尔森-罗马合并症指数及他汀类药物、利尿剂、ACEI、β受体阻滞剂的使用。HR用95%的CI计算。敏感性分析被认为一个较长的基线期（365天和183 天）和个人合并症。

结果：有9244人使用别嘌呤醇，有8569例受益者，其中有1366人(14.8%)患有房颤。多变量调整分析后，别嘌呤醇的使用与HR的0.83(95% CI 0.74到0.93)房颤相关联。在一个单独的多变量调整模型中，将没有使用别嘌呤醇与长时间持续使用别嘌呤醇相比较，则有一个较为低的房颤HR，180天到2年0.85(95% CI 0.73到0.99)和＞2年0.65(95% CI 0.52到0.82)。其他值得注意的影响因素可能与房颤高风险有关：年龄在75-85岁之间与≥85岁，更高的察尔森得分指数，β受体阻滞剂的使用。敏感性分析通过最小/无衰减的HRs证实了这些发现。

结论：使用别嘌醇可降低中老年人房颤发生的风险，尤其是使用时间大于6个月。进一步研究可着眼于评估并确定别嘌呤醇上述益处的发生机制。

Ann Rheum Dis. 2016
May 10.

Allopurinol and the risk of atrial fibrillationin the elderly: astudy using Medicare data.

    Singh JA1, Yu S2.

Abstract

OBJECTIVE:

To assess the effect of allopurinol use on the risk of incident atrial
fibrillation (AF) in the elderly.

METHODS:

We used the 5% random Medicare Claims data from 2006 to 2012 to examine
the association of allopurinol use and incident AF in a cohort of patients with
an absence of AF at baseline (at least 365 days). Multivariable-adjusted Cox
regression analyses compared allopurinol exposed and non-exposed periods for
the risk of AF, controlling for age, sex, race, Charlson-Romano comorbidity
index and use of statins, diuretics, ACE inhibitors and β-blockers. HR with 95%
CIs was calculated. Sensitivity analyses considered a longer baseline period
(365 days vs 183 days) and individual comorbidities.

RESULTS:

There were 9244 episodes of incident allopurinol use in 8569
beneficiaries, of which 1366 episodes (14.8%) had incident AF. In
multivariable-adjusted analyses, allopurinol use was associated with an HR of
0.83 (95% CI 0.74 to 0.93) for incident AF. In a separate
multivariable-adjusted model, compared with no allopurinol use, longer
allopurinol use durations were associated with a lower HR of AF:
180 days-2 years, 0.85 (95% CI 0.73 to 0.99) and >2 years, 0.65 (95% CI 0.52
to 0.82). Other factors significantly associated with a higher hazard of AF
were: age 75-<85 years and ≥85 years, higher Charlson index score and
current β-blocker use. Sensitivity analyses confirmed these findings with
minimal/no attenuation of HRs.

CONCLUSIONS:

Allopurinol use was associated with a reduced risk of incident AF in the
elderly, especially its use for >6 months duration. Future studies should
assess the mechanisms underlying this beneficial effect of allopurinol.

编译者：西京医院临床免疫科 牛敏

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