Effect of allopurinol on mortality and hospitalisations in chronic heart failure: a retrospective cohort study
Effect of allopurinol on mortality and hospitalisations in chronic heart failure: a retrospective cohort study
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DOI：
10.1136/heart.87.3.229
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发表时间：
2002-03-01
期刊：
影响因子：
5.7
通讯作者：
MacDonald, TM
中科院分区：
文献类型：
--
作者：
Struthers, AD;Donnan, PT;MacDonald, TM
目的：研究别嘌呤醇是否与慢性心力衰竭（CHF）患者死亡率和住院率的任何改变有关。这一假设是基于以前的数据，即高尿酸盐浓度与CHF死亡率独立相关，风险比为4.23。设计：回顾性队列研究。设置：药物监测单位，Ninewells医院，邓迪，英国。患者：1760名CHF患者分为四组：不服用别嘌呤醇、长期服用低剂量别嘌呤醇、短期服用低剂量别嘌呤醇和长期服用高剂量别嘌呤醇的患者。主要结果测量：总死亡率，心血管死亡率，心血管住院，心血管死亡率或hospitalisation.Results：长期低剂量别嘌呤醇与那些谁从来没有收到别嘌呤醇死亡率显着恶化（相对危险度2.04，95%置信区间（CI）1.48至2.81）。这可能是因为低剂量的别嘌呤醇不足以消除高浓度口服给药的副作用。然而，长期高剂量（大于或等于300 mg/天）别嘌呤醇与长期低剂量别嘌呤醇的死亡率显著相关（相对风险0.59，95% CI 0.37至0.95）。这可能意味着，高剂量别嘌呤醇可以完全否定尿酸盐的不良影响，并返回的死亡率normall.Conclusions：长期高剂量别嘌呤醇可能与一个更好的死亡率比长期低剂量别嘌呤醇在CHF患者，因为剂量相关的有益效果，别嘌呤醇对尿酸盐的不良反应。需要进一步的工作来证实或反驳这一发现。
Objective: To examine whether allopurinol is associated with any alteration in mortality and hospitalisations in patients with chronic heart failure (CHF). This hypothesis is based on previous data that a high urate concentration is independently associated with mortality with a risk ratio of 4.23 in CHF.Design: Retrospective cohort study.Setting: Medicines Monitoring Unit, Ninewells Hospital, Dundee, UK.Patients: 1760 CHF patients divided into four groups: those on no allopurinol, those on long term low dose allopurinol, those on short term low dose allopurinol, and those on long term high dose allopurinol.Main outcome measures: Total mortality, cardiovascular mortality, cardiovascular hospitalisations, cardiovascular mortality or hospitalisations.Results: Long term low dose allopurinol was associated with a significant worsening in mortality over those who never received allopurinol (relative risk 2.04, 95% confidence interval (Cl) 1.48 to 2.81). This may be because low dose allopurinol is insufficient to negate the adverse effect of a high orate concentration. However, long term high dose (greater than or equal to 300 mg/day) allopurinol was associated with a significantly better mortality than longstanding low dose allopurinol (relative risk 0.59, 95% Cl 0.37 to 0.95). This may mean that high dose allopurinol can fully negate the adverse effect of urate and return the mortality to normal.Conclusions: Long term high dose allopurinol may be associated with a better mortality than long term low dose allopurinol in patients with CHF because of a dose related beneficial effect of allopurinol against the well described adverse effect of urate. Further work is required to substantiate or refute this finding.