Lifetime nonnarcotic analgesic use and decline in renal function in women
Lifetime nonnarcotic analgesic use and decline in renal function in women
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DOI：
10.1001/archinte.164.14.1519
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发表时间：
2004-07-26
影响因子：
--
通讯作者：
Stampfer, MJ
中科院分区：
文献类型：
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作者：
Curhan, GC;Knight, EL;Stampfer, MJ
背景：镇痛药很常用，可能会损害肾功能。然而，关于阿司匹林、其他非甾体类抗炎药 (NSAID) 和对乙酰氨基酚对肾功能的长期影响，可获得的前瞻性信息有限。方法：共有 1697 名参与护士健康研究的女性在 1999 年邮寄的调查问卷上提供了有关对乙酰氨基酚、阿司匹林和 NSAID 终生使用情况的信息，并提供了 1989 年和 2000 年的血液样本。主要结果是11 年来估计的肾小球滤过率 (GFR)。使用多变量逻辑回归来确定根据终生镇痛剂摄入量产生结果的几率。结果：平均 SD 估计 GFR 从每 1.73 m(2) 88 +/- 17 下降到 79 +/- 17 mL/min。在基线时或 11 年后，3 个镇痛药组的终生摄入量类别中未调整或估计的 GFR 水平没有显着差异。对乙酰氨基酚的使用与每 1.73 m(2) 至少 30 mL/min 的 GFR 下降（P 趋势 = .01）以及 GFR 下降 30% 或更大（P 趋势 < .001）的风险增加相关，但使用阿司匹林和 NSAID 则不然。与对乙酰氨基酚摄入量少于 100 g 的女性相比，摄入量超过 3000 g 的女性每 1.73 m(2) GFR 下降至少 30 mL/min 的多变量调整比值比（95% 置信区间）为 2.04 (1.28-3.24)。 结论：终生服用阿司匹林和 NSAID 的次数增多与肾功能下降无关，但与肾功能下降相关。使用对乙酰氨基酚可能会增加肾功能丧失的风险。即使终生服用大量镇痛药，导致肾功能下降的绝对风险似乎也很小。
Background: Analgesics are commonly used and may impair kidney function. However, limited prospective information is available on the long-term effects of aspirin, other nonsteroidal anti-inflammatory drugs (NSAIDs), and acetaminophen on renal function.Methods: A total of 1697 women participating in the Nurses' Health Study provided information on a mailed questionnaire in 1999 about lifetime use of acetaminophen, aspirin, and NSAIDs and provided blood samples in 1989 and 2000. The main outcome was change in estimated glomerular filtration rate (GFR) in 11 years. Multivariate logistic regression was used to determine the odds of developing the outcome according to lifetime analgesic intake.Results: The mean SD estimated GFR decreased from 88 +/- 17 to 79 +/- 17 mL/min per 1.73 m(2). There were no substantial differences in the unadjusted or estimated GFR levels among the categories of lifetime intake for the 3 analgesic groups at baseline or after 11 years. Acetaminophen use was associated with an increased risk of a GFR decline of at least 30 mL/min per 1.73 m(2) (P trend = .01) and a GFR decline of 30% or greater (P trend < .001), but aspirin and NSAID use were not. Compared with women consuming less than 100 g of acetaminophen, multivariate-adjusted odds ratio (95% confidence intervals) for a decline in GFR of at least 30 mL/min, per 1.73 m(2) for women consuming more than 3000 g was 2.04 (1.28-3.24).Conclusions: Higher lifetime use of aspirin and NSAIDs is not associated with renal function decline, but high acetaminophen use may increase the risk of loss of renal function. The absolute risk of renal function decline due to even high lifetime analgesic intake seems to be modest.