肺癌是COPD患者的常見死因之一,。為了探討吸入性皮質(zhì)類固醇治療是否有助于降低COPD患者發(fā)生肺癌的危險，在一項包含10474例罹患 COPD的美國退伍軍人的研究中,，研究人員David H. Au等人進行了為期3.8年（中位數(shù)）的追蹤調(diào)查,。
在這項研究中，經(jīng)過調(diào)整年齡,、吸煙狀況,、吸煙強度,、過去之非肺癌惡性腫瘤病史、基礎(chǔ)疾病和支氣管擴張劑治療情況后,，發(fā)現(xiàn)接受吸入性皮質(zhì)類固醇治療的COPD患者中,，肺癌發(fā)病危險隨著吸入性皮質(zhì)類固醇治療劑量的增加，而呈現(xiàn)出劑量效應(yīng)地降低,。吸入性皮質(zhì)類固醇劑量<1200 μg/日的受試者,，發(fā)生肺癌的風(fēng)險比為1.13，而≥1200 μg/日者為0.39,。
這項研究結(jié)果顯示,，對于COPD患者而言，吸入性皮質(zhì)類固醇可能具有潛在的預(yù)防肺癌效果,。不過這只是初步結(jié)果而已,，還需要更多大規(guī)模研究來驗證這項結(jié)果。
本研究發(fā)表于2007年4月出刊的American Journal of Respiratory and Critical Care Medicine中,。
(資料來源 : Bio.com)
部分英文原文：
American Journal of Respiratory and Critical Care Medicine Vol 175. pp. 712-719, (2007)Original Article
Inhaled Corticosteroids and Risk of Lung Cancer among Patients with Chronic Obstructive Pulmonary Disease
Tanyalak Parimon1,*, Jason W. Chien1,2,*, Chris L. Bryson1,3, Mary B. McDonell3, Edmunds M. Udris1,2 and David H. Au1,3
1 Department of Medicine, University of Washington, Seattle, Washington; 2 Clinical Research Division, Fred Hutchison Cancer Research Center, Seattle, Washington; and 3 Health Services Research and Development, VA Puget Sound Health Care System, Seattle, Washington
Correspondence and requests for reprints should be addressed to David H. Au, M.D., M.S., Health Services Research and Development (MS152), VA Puget Sound Health Care System, 1100 Olive Way, Suite 1400, Seattle, WA 98101. E-mail: [email protected]
Rationale and Objectives: Lung cancer is a frequent cause of death among patients with chronic obstructive pulmonary disease (COPD). We examined whether the use of inhaled corticosteroids among patients with COPD was associated with a decreased risk of lung cancer.
Methods: We performed a cohort study of United States veterans enrolled in primary care clinics between December 1996 and May 2001. Participants had received treatment for, had an International Classification of Disease, 9th edition, diagnosis of, or a self-reported diagnosis of COPD. Patients with a history of lung cancer were excluded. To be exposed, patients must have been at least 80% adherent to inhaled corticosteroids. We used Cox regression models to estimate the risk of cancer and adjust for potential confounding factors.
Findings: We identified 10,474 patients with a median follow-up of 3.8 years. In comparison to nonusers of inhaled corticosteroids, adjusting for age, smoking status, smoking intensity, previous history of non–lung cancer malignancy, coexisting illnesses, and bronchodilator use, there was a dose-dependent decreased risk of lung cancer associated with inhaled corticosteroids (ICS dose < 1,200 µg/d: adjusted HR, 1.3; 95% confidence interval, 0.67–1.90; ICS dose 1,200 µg/d: adjusted HR, 0.39; 95% confidence interval, 0.16–0.96). Changes in cohort definitions had minimal effects on the estimated risk. Analyses examining confounding by indication suggest biases in the opposite direction of the described effects.
Interpretation: Results suggest that inhaled corticosteroids may have a potential role in lung cancer prevention among patients with COPD. These initial findings require confirmation in separate and larger cohorts.
Key Words: chronic obstructive pulmonary disease • pharmacoepidemiology • lung cancer • adherence
