Statin use and calcific uremic arteriolopathy: a matched case-control study.
Statin use and calcific uremic arteriolopathy: a matched case-control study.
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DOI：
10.1159/000348806
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发表时间：
2013
影响因子：
4.2
通讯作者：
Thadhani R
中科院分区：
文献类型：
--
作者：
Nigwekar SU;Bhan I;Turchin A;Skentzos SC;Hajhosseiny R;Steele D;Nazarian RM;Wenger J;Parikh S;Karumanchi A;Thadhani R
钙化性尿毒症动脉病(CUA)，又称钙质疏松症，以血管钙化、血栓形成和剧烈炎症为特征。先前的研究表明，他汀类药物具有抗钙化、抗血栓和抗炎的特性；然而，他汀类药物的使用与CUA之间的关系尚未被研究。这项配对的病例对照研究包括62名成人维持性血液透析(HD)患者，他们在2002年至2011年间确诊为经活检证实的CUA(病例)。所有病例均在确诊时入院治疗。对照组(n=124)为无CUA的维持性HD患者(与患者性别、住院时间相匹配)。应用单变量和多变量Logistic回归模型计算他汀类药物使用者CUA的优势比(OR)和95%可信区间(CI)，并检验先前描述的相关性。病例的平均年龄为58岁。大多数为女性(68%)，白人(%)。对照组中他汀类药物的使用比病例组更常见(39%比19%，p<；0.01)。在未调整(OR 0.38，95%CI 0.18-0.79)和调整(OR 0.20，95%CI 0.05-0.88)分析中，他汀类药物的使用与较低的CUA发生几率相关。在校正分析中，高血钙症(OR 2.25，95%CI 1.14~4.43)、低蛋白血症(OR 5.73，95%CI 2.79~11.77)、使用骨化三醇(OR 5.69，95%CI 1.02~31.77)和使用华法林(OR 4.30，95%CI 1.57~11.74)与CUA呈正相关，而骨钙醇和多沙钙化醇与CUA无关(OR 1.33，95%CI 0.54~3.27)。他汀类药物的使用可能与CUA的发生几率呈负相关。进一步的大型前瞻性研究需要关注潜在的混杂因素来证实这些发现。
Calcific uremic arteriolopathy (CUA), also known as calciphylaxis, is characterized by vascular calcification, thrombosis and intense inflammation. Prior research has shown that statins have anticalcification, antithrombotic and antiinflammatory properties; however, the association between statin use and CUA has not been investigated. This matched case-control study included 62 adult maintenance hemodialysis (HD) patients with biopsy-confirmed CUA diagnosed between the years 2002 and 2011 (cases). All cases were hospitalized at the time of diagnosis. Controls (n = 124) were hospitalized maintenance HD patients without CUA (matched to cases by gender and timing of hospitalization). Univariate and multivariable logistic regression models were applied to compute odds ratio (OR) and 95% confidence intervals (CI) for CUA in statin users, and also to examine previously described associations. The mean age of cases was 58 years. Most were females (68%), and of white race (64%). Statin use was more common in controls than in cases (39 vs. 19%, p < 0.01). Statin use was associated with lower odds of CUA in unadjusted (OR 0.38, 95% CI 0.18–0.79) and adjusted (OR 0.20, 95% CI 0.05–0.88) analyses. Hypercalcemia (OR 2.25, 95% CI 1.14–4.43), hypoalbuminemia (OR 5.73, 95% CI 2.79–11.77), calcitriol use (OR 5.69, 95% CI 1.02–31.77) and warfarin use (OR 4.30, 95% CI 1.57–11.74) were positively associated with CUA in adjusted analyses whereas paricalcitol and doxercalciferol were not (OR 1.33, 95% CI 0.54–3.27). Statin use may be negatively associated with odds of CUA. Further large prospective studies with attention to potential confounders are needed to confirm these findings.
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