Simvastatin and Disease Stabilization in Normal Tension Glaucoma: A Cohort Study
Simvastatin and Disease Stabilization in Normal Tension Glaucoma: A Cohort Study
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DOI：
10.1016/j.ophtha.2009.08.016
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发表时间：
2010-03-01
期刊：
影响因子：
13.7
通讯作者：
Lam, Dennis S. C.
中科院分区：
文献类型：
--
作者：
Leung, Dexter Y. L.;Li, Felix C. H.;Lam, Dennis S. C.
目的：研究在正常眼压性青光眼(NTG)患者中使用辛伐他汀是否与视野稳定有关。设计：前瞻性队列研究(ClinicalTrials.gov，识别号：NCT00321386)。对象：256例(256只眼)患有NTG的中国患者。方法：根据Anderson标准，每隔4个月对患者进行为期36个月的室颤进展的随访。结果：31名患者(12.1%)服用辛伐他汀(他汀类药物+)，225名患者(87.9%)未服用辛伐他汀(他汀类药物)。两组的基线年龄、性别、未经治疗的眼压、VF指数、垂直杯盘比和中央角膜厚度(CCT)具有可比性。在他汀类药物+组中，有高胆固醇血症、全身性高血压和缺血性心脏病病史的患者明显更多。在36个月的随访中，共有121名患者(47.3%)表现出室颤进展(平均偏差丢失率为-0.30分贝/年)。进展的8例(6.6%)患者中有8例(6.6%)使用辛伐他汀，而在135例无进展的患者中有23例(17.0%)使用辛伐他汀(P=0.011)。Logistic回归分析显示，椎间盘出血病史(相对危险度3.26；95%可信区间1.21-8.76；P=0.019)、脑血管意外史(RR2.28；95%可信区间1.03-5.06；P=0.043)和基线年龄(每10岁年龄；RR1.38；95%CI，1.08-1.76；P=0.009)是VF进展的显著危险因素，而辛伐他汀具有保护作用(RR0.36；结论：辛伐他汀的应用可能与非胰岛素依赖型糖尿病患者的室颤稳定有关。更大规模的随机对照试验和成本-效果分析似乎是有必要的。财务披露(S)：作者对本文讨论的任何材料都没有专有或商业利益。眼科2010；美国眼科学会117：471-476(C)2010。
Purpose: To investigate whether simvastatin use is associated with visual field (VF) stabilization in patients with normal tension glaucoma (NTG).Design: Prospective cohort study (ClinicalTrials.gov Identifier: NCT00321386). Participants: A total of 256 eyes from 256 Chinese subjects with NTG.Methods: Patients were followed up at 4-month intervals for 36 months for VF progression per Anderson's criteria. Clinical parameters were checked for association with progression in multivariate analysis.Main Outcome Measures: The primary outcome was the association between simvastatin use and VF progression.Results: Thirty-one patients (12.1%) were taking simvastatin (statin+), and 225 patients (87.9%) were not taking simvastatin (statin-). Baseline age, gender, untreated intraocular pressure, VF indices, vertical cup-todisc ratio, and central corneal thickness (CCT) were comparable between the 2 groups. There were significantly more patients with a history of hypercholesterolemia, systemic hypertension, and ischemic heart disease in the statin+ group. A total of 121 patients (47.3%) showed evidence of VF progression (mean rate of mean deviation loss was -0.30 decibel per year) during the 36 months of follow-up. Simvastatin use was among 8 of 121 patients (6.6%) who progressed compared with 23 of 135 patients (17.0%) who did not progress (P = 0.011). Logistic regression revealed that history of disc hemorrhage (relative risk [RR] 3.26; 95% confidence interval [CI], 1.21-8.76; P = 0.019), history of cerebrovascular accidents (RR 2.28; 95% CI, 1.03-5.06; P = 0.043), and baseline age (per 10 years older; RR 1.38; 95% CI, 1.08-1.76; P = 0.009) were significant risk factors for VF progression, whereas simvastatin use conferred a protective effect (RR 0.36; 95% CI, 0.14-0.91; P = 0.030).Conclusions: Simvastatin use may be associated with VF stabilization in patients with NTG. A larger scale randomized controlled trial and cost-effectiveness analyses seem warranted.Financial Disclosure(s): The authors have no proprietary or commercial interest in any materials discussed in this article. Ophthalmology 2010; 117: 471-476 (C) 2010 by the American Academy of Ophthalmology.