Do angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers decrease the risk of hospitalization secondary to community-acquired pneumonia? A nested case-control study
Do angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers decrease the risk of hospitalization secondary to community-acquired pneumonia? A nested case-control study
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DOI：
10.1592/phco.26.4.479
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发表时间：
2006-04-01
期刊：
影响因子：
4.1
通讯作者：
Brophy, JM
中科院分区：
文献类型：
--
作者：
Etminan, M;Zhang, B;Brophy, JM
研究目的。由于研究表明，血管紧张素转换酶（ACE）抑制剂可能通过增加咳嗽反射降低发生肺炎的风险，因此我们试图探索ACE抑制剂的使用与继发于社区获得性肺炎（CAP）的住院风险之间的潜在相关性。为了进一步验证这一假设，我们还研究了服用血管紧张素II受体阻滞剂（ARB）的患者发生CAP的风险，因为这些药物与ACE抑制剂的作用机制相似，但对咳嗽反射的影响极小或无影响。此外，假定的对肺炎的保护可能与对肾素-血管紧张素系统的一般抑制有关。巢式病例对照研究数据来源。Universal魁北克，加拿大，行政卫生数据库。从1996年至2000年期间接受血运重建手术的47，148例冠状动脉疾病患者队列中，确定了1666例CAP患者和33，315例时间匹配的对照受试者（每例20例对照）。有条件的。逻辑回归分析用于估计率比，同时控制潜在的混杂因素。未观察到接受ACE抑制剂治疗的患者与因CAP住院治疗之间存在关联（率比[RR] 0.98，95%置信区间[CI] 0.69-1.40）。在接受ARB治疗的患者中也观察到类似的缺乏相关性（RR 1.02，95% CI 0.70-1.49）。在这项病例对照研究中，未发现ACE抑制剂或ARB的使用与继发于CAR的住院风险之间存在相关性。未来的研究有必要进一步探讨这种相关性。
Study Objective. As studies have shown that angiotensin-converting enzyme (ACE) inhibitors may lower the risk of developing pneumonia by increasing the cough reflex, we sought to explore the potential association between use of ACE inhibitors and the risk of hospitalization secondary to community-acquired pneumonia (CAP). To test this hypothesis further, we also looked at the risk for CAP in those taking angiotensin II receptor blockers (ARBs), as these drugs have a similar mechanism of action to that of ACE inhibitors but have minimal or no effect on the cough reflex. In addition, the putative protection against pneumonia may instead be related to general inhibition of the renin-angiotensin system.Design. Nested case-control studyData Source. Universal Quebec, Canada, administrative health databases.Patients. From a cohort of 47,148 patients with coronary artery disease who had a revascularization procedure between 1996 and 2000, 1666 patients with CAP and 33,315 time-matched control subjects (20 controls for each case) were identified.Measurements and Main Results. Conditional. logistic regression analysis was used to estimate rate ratios, while controlling for potential confounders. No association was observed between patients receiving ACE inhibitors and hospitalization for CAP (rate ratio [RR] 0.98, 95% confidence interval [CI] 0.69-1.40). A similar lack of association was noted for those receiving ARBs (RR 1.02, 95% CI 0.70-1.49).Conclusion. In this case-control study, no association was found between use of ACE inhibitors or ARBs and risk of hospitalization secondary to CAR Future studies are necessary to explore this association further.