終末期腎臟病病患使用血管收縮素受體阻斷劑影響重大心血管事件的風險

Abstract

背景：罹患終末期腎臟病（End stage renal disease，ESRD）將增加心血管疾病的風險。研究表明心血管疾病的發生與腎臟的惡化直接相關。血管收縮素受體阻斷劑（Angiotensin II receptor blocker，ARB）具有延緩腎臟惡化功效，本研究欲評估ARB藥物是否對ESRD患者具有降低重大心血管事件（Major adverse cardiovascular event，MACE）風險的效果。方法：本研究使用全民健康保險研究資料庫，觀察2000年七月至2005年十二月ESRD病患ARB累積給日藥大於九十天、九十天內對照未服用ARB藥物病患追蹤五年後MACE之發展情形。結果：在校正性別、年齡和共病干擾後，ARB累積給藥日大於90天者相較於非使用者顯著降低MACE風險（HR= 0.69，95％CI= 0.58-0.82，p< 0.001）、ARB累積給藥日90天內者MACE風險比與非使用者無顯著差異（HR= 0.99，95% CI= 0.80-1.22）。不分種類ARB藥物累積給藥日達366天以上將能顯著降低MACE風險（累積給藥日366-1095天：HR= 0.64，95％CI= 0.50-0.81，p< 0.001；累積給藥日大於1095天：HR= 0.24，95％CI= 0.13-0.44，p< 0.001）。ARB累積給藥日365天內與非使用者相比高血鉀風險顯著增加。與高血壓患者非ARB使用者相比，Losartan（HR= 0.44，95% CI= 0.30-0.66，p< 0.001）、Valsartan（HR= 0.52，95% CI= 0.36-0.75，p< 0.05）有顯著降低MACE風險的效果、Irbesartan則無顯著差異。病患具有高血壓、糖尿病及高血脂情況下，ARB累積給藥日91-365天（HR= 0.59，95% CI= 0.39-0.89，p< 0.05）、366-1095天（HR= 0.49，95% CI= 0.31-0.77，p< 0.05）及大於1095天（HR= 0.22，95% CI= 0.08-0.62，p< 0.05）均有顯著降低MACE風險的效果。結論：ARB藥物有助於ESRD病患降低MACE風險，但相關機制有待進一步探討。

Background: End-stage renal disease (ESRD) will increase the risk of cardiovascular disease. Studies have shown that the occurrence of cardiovascular disease is directly related to renal deterioration. Angiotensin II receptor blocker (ARB) has the effect of delaying the deterioration of renal. This study wants to evaluate whether ARB therapy for reduced major adverse cardiovascular event (MACE) risk in ESRD patients. Methods: This study used the National Health Insurance Research Database observed from July 2000 to December 2005 ESRD patients with/without ARB. 739 of the patients received ARB therapy, and 1061 are not (ARB(-)). Among them, 515 patients cumulative prescription more than 90 days (ARB(++)); 224 patients are less than or equal to 90 days (ARB(+)). Each patient was followed for the occurrences of MACE. Results: The adjusted hazard ratio (HR) of MACE was 0.69 (95% CI= 0.58-0.82, p< 0.001) for ARB(++) patients, compared with ARB(-) patients. The occurrence of MACE was significantly different between ARB users and non-users among those with cumulative prescription between 366–1095 days (HR= 0.64, 95% CI=0.50-0.81, p<0.001) and more than 1095 days (HR= 0.24, 95% CI= 0.13-0.44, p<0.001). Losartan (HR= 0.44, 95% CI= 0.30-0.66, p< 0.001) and Valsartan (HR= 0.52, 95% CI= 0.36-0.75, p< 0.05) have significant lower risk of MACE. Patients with hypertension, diabetes and hyperlipidemia received ARB therapy with cumulative prescription more than 91 days they are significant low risk of MACE. Conclusions: ARB therapy may help reduce the development of MACE. However, the associated mechanisms must be further explored and identified.