經常使用阿斯匹靈與老化黃斑病變有關


  【24drs.com】經常使用阿斯匹靈和早發型老化黃斑病變(aging macula disorder,AMD)有關,也和濕性遲發型AMD有關,這些風險都與使用阿斯匹靈的頻率有關。
  
  這些線上刊載於9月13日眼科學誌(Ophthalmology)的研究,涵蓋了近4,700名65歲以上的歐洲病患。
  
  阿姆斯特丹荷蘭神經科學暨學院醫學中心的Paulus T.V.M. de Jong博士等人寫道,使用阿斯匹靈與AMD之間的關聯已經有多所描述,但是結果並不一致。
  
  為了進一步瞭解這個關聯,de Jong博士等人進行了一個橫斷面、人口基礎的研究,使用結構式訪談評估使用阿斯匹靈和AMD的關聯,研究對象是4,691名挪威、愛沙尼亞、英國、法國、義大利、希臘與西班牙的居民。
  
  除了詢問使用阿斯匹靈的情況,也訪問研究對象的社會人口統計學資料、教育程度、目前與以前的抽菸史、飲酒情況;其他問題則聚焦在醫療史,包括中風或心肌梗塞史,是否曾經診斷有心絞痛或糖尿病。
  
  使用阿斯匹靈的情況分為七類,範圍從「未曾使用」到「每天使用」;也抽取空腹血液樣本檢測膽固醇值。
  
  之後拍攝研究對象的數位眼底影像,並送往分級中心,由2名有經驗的工作人員判讀;影像分級依據為「老化黃斑部病變之國際分類與分級系統」。
  
  研究人員定義乾性AMD為視網膜色素上皮細胞明顯缺乏明確的圓形或橢圓形區域,最大直徑超過175 μm,可看見脈絡膜血管,沒有出現濕性AMD。
  
  濕性AMD定義為視網膜色素上皮細胞、視網膜下新血管膜出現出血型病變,視網膜下出血、視網膜周邊纖維性結疤、或者併發這些特徵,只要有這些特徵,就算眼底影像顯示為乾性AMD,都必須歸為濕性。
  
  作者們報告指出,36.4%的研究對象有早發型AMD,3.3%為遲發型AMD。
  
  約41%的研究對象表示每月使用阿斯匹靈,7%表示每週至少使用一次,17.3%表示每天使用。
  
  研究人員寫道,對於每天使用者,校正可能的共變項之後,勝算比顯示,AMD等級的嚴重度隨之逐漸增加,校正心血管疾病或心絞痛等已知的共變項時,關聯不變,不過,可能有其他未被發現的共變項。
  
  隨等級相對增加的嚴重度分述如下:等級1為1.26 (95%信心區間[CI],1.08 - 1.46;P < .001);等級2為1.42 (95% CI,1.18 - 1.70);濕性遲發性AMD為2.22 (95% CI,1.61 - 3.05;P < .001)。
  
  作者們表示必須謹慎詮釋這篇研究結果,他們指出,這是一個橫斷面研究,AMD患者發生視力問題後服用阿斯匹靈的可能性無法被排除。另外的研究限制是,研究對象可能說錯心血管病史,導致分析錯誤。不過,作者們表示,希望藉由詢問心臟病發作和中風等嚴重事件、並記錄事件日期而盡量減少誤報。
  
  作者們結論表示,雖然有這些研究限制,但這篇有趣的觀察讓我們知道必須對使用阿斯匹靈和AMD之間的關聯進行後續評估。
  
  資料來源:http://www.24drs.com/professional/list/content.asp?x_logon=W&x_idno=6627&x_classno=0
  

Frequent Aspirin Use Tied to Aging Macula Disorder

By Steven Fox
Medscape Medical News

October 11, 2011 — Frequent use of aspirin is associated with early aging macula disorder (AMD), as well as wet late AMD, and risks for those problems appear to be linked to how often aspirin is consumed.

Those findings are from a study of nearly 4700 European patients aged 65 years or older that was published online September 13 in Ophthalmology.

"Associations between aspirin use and AMD have been addressed in various settings with inconsistent results," write Paulus T.V.M. de Jong, MD, PhD, from the Netherlands Institute for Neuroscience and Academic Medical Center, Amsterdam, and colleagues.

To find out more about that possible association, Dr. de Jong and colleagues conducted a cross-sectional, population-based study using structured interviews to assess aspirin use and AMD in 4691 people who lived in 7 European countries: Norway, Estonia, United Kingdom, France, Italy, Greece, and Spain.

In addition to being queried about their aspirin use, the participants were also asked about their sociodemographic status, educational level, current and past smoking history, and consumption of alcohol. Other questions focused on their medical history, including history of stroke or myocardial infarction, and whether they had been diagnosed with either angina or diabetes mellitus.

Aspirin use was gauged using a precoded response category of 7 options that ranged from "never" to "daily."

Cholesterol levels were also determined using fasting blood samples.

Digitized fundus images were then obtained from participants, and the images sent to a grading center and evaluated by 2 experienced staffers. The images were graded according to the International Classification and Grading System for Age-Related Maculopathy and AMD.

The researchers defined dry AMD as any sharply demarcated round or oval area of apparent absence of the retinal pigment epithelium, with the largest diameter more than 175 μm, with visible choroidal vessels, and with no presence of wet AMD.

Wet AMD was defined as the presence of a serous or hemorrhagic detachment of the retinal pigment epithelium, a subretinal neovascular membrane, subretinal hemorrhage, periretinal fibrous scarring, or a combination of those characteristics. That definition held even when fundus images showed patches of dry AMD.

The authors report that 36.4% of the participants had evidence of early AMD and 3.3% had evidence of late AMD.

About 41% of participants reported monthly aspirin use, 7% reported using aspirin at least once weekly, and 17.3% reported daily use.

"For daily aspirin users, the [odds ratios], adjusted for potential confounders, showed a steady increase with increasing severity of AMD grades," the researchers write. "When adjustment was made for all known confounders including [cardiovascular disease] or angina, the associations did not change. However, there may be other confounders that were not measured," they write.

Those relative increases in severity were noted as follows: grade 1, 1.26 (95% confidence interval [CI], 1.08 - 1.46; P < .001); grade 2, 1.42 (95% CI, 1.18 - 1.70); and wet late AMD, 2.22 (95% CI, 1.61 - 3.05; P < .001).

The authors advise caution in interpreting the results of the study. "This was a cross-sectional study, and the possibility that people with AMD took aspirin after experiencing visual problems cannot be excluded," they note. Another limitation is that “[i]t is possible that participants incorrectly reported their [cardiovascular disease] history, leading to residual confounding and measurement error.” However, the authors say, "[t]he protocol attempted to minimize misreporting by asking about serious events such as heart attack and stroke and also recorded the date of the event."

Even with the limitations of the study, however, the authors conclude, "[t]his interesting observation warrants further evaluation of the associations between aspirin use and AMD."

The study was supported by the European Commission Vth Framework, Brussels, Belgium. Funding for cameras was provided by the Macular Disease Society UK. Additional funding in Alicante, Spain, was provided by the Spanish Ministry of Health, Madrid, and CIBER de Epidemiologi’ y Salud Publica and the Generalitat Valenciana, both in Valencia. One author received support from the Estonian Ministry of Education and Science. The authors have disclosed no relevant financial relationships.

Ophthalmology. Published online September 13, 2011.

    
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