作者：Martha Kerr
出處：WebMD醫學新聞
October 27, 2008(賓州費城) — 根據美國胸腔醫學會第74屆年度科學會議CHEST 2008中的研究，固態腫瘤住院病患接受statin類藥物治療者，靜脈血栓(VTE)的風險顯著比未服用降血脂藥物者低。
主要研究者、賓州愛因斯坦醫學中心內科部住院醫師Danai Khemasuwan發表這篇回溯案例控制研究的結果。
這項研究包括740名因為乳房、肺部、大腸、前列腺、胃、食道、胰臟、卵巢、腎臟與腦部等癌症而於2004年10月至2007年9月間住院的患者，他們的平均年紀為65歲，研究對象男女約各半數，76%為非洲裔美國人；住院前接受抗凝血治療的病患排除於本研究之外。
研究者將病患分為使用和未使用statin者，住院前服用statin不到兩個月者被指定為控制組。Khemasuwan醫師於發表之後接受Medscape Pulmonary Medicine的訪問時表示，這是因為C反應蛋白質在八週左右達穩定，顯示最佳抗發炎效果；整體來說，研究中有26% (n= 194) 的病患使用statin類藥物。
整體研究對象的VTE發生率為18% (n= 132)；而statin使用者的發生率為8% (n= 16)，控制組則為21% (n= 116; 勝算比(odds ratio [OR]), 0.33;95% CI, 0.192 – 0.578; P?< .001)。
Khemasuwan醫師報告指出，當根據VTE的風險因素，如抽菸、轉移癌症、現正使用化療、臥床、使用阿斯匹靈等進行分析時，結果仍然相同。
他表示，即使將我可以發現的所有共變項都納入，降低的風險仍然很顯著；雖然阿斯匹靈無法像前幾年的報告所提般幫助降低VTE風險，但statin類藥物可以有幫助。
他認為，許多醫師因為認為弊大於利而停止讓癌症病患使用statin類藥物，如果此研究發現獲得確認，或許未來這會是statin類藥物的另一個適應症；statin類藥物可以減少此類病患的VTE風險。
威斯康辛醫學院資深研究副主任、美國胸腔醫學會健康與科學政策委員會前主席David D. Gutterman醫師向Medscape Pulmonary Medicine表示，這有諸多意義，特別是因為statin類藥物的多效性；Gutterman醫師擔任愛因斯坦醫學中心發表研究發現時的會議主持人。
Gutterman醫師指出，statin類藥物的內皮效果可能比抗發炎效果更重要，在靜脈的這個效果也許和在動脈發生的效果一樣重要。
Gutterman醫師向Khemasuwan醫師建議指出，對同樣有高風險的不同族群進行類似研究將會是有趣的，而這在你還是住院醫師時更容易進行！
Khemasuwan 醫師和Gutterman 醫師都宣稱沒有相關資金上的往來。
CHEST 2008: 美國胸腔醫學會第74屆年度科學會議：摘要AS2202。發表於2008年10月27日。
Statins Appear to Prevent VTE in Hospitalized Cancer Patients
By Martha Kerr
Medscape Medical News
October 27, 2008 (Philadelphia, Pennsylvania) — Patients hospitalized with solid tumors who are also on statin therapy have a significantly lower risk for venous thromboembolism (VTE) than those not taking the lipid-lowering agents, according to research presented here at CHEST 2008, the American College of Chest Physicians 74th Annual Scientific Assembly.
Results of a retrospective case–control study were presented by principal investigator Danai Khemasuwan, MD, a resident in the Department of Internal Medicine at Albert Einstein Medical Center in Philadelphia, Pennsylvania.
The study involved 740 consecutive patients admitted with a variety of solid tumors, including breast, lung, colon, prostate, stomach, esophagus, pancreas, ovary, kidney, and brain cancer, between October 2004 and September 2007. Mean age was 65 years. The study population was roughly half men and half women, and 76% were African American. Patients treated with anticoagulation therapy before hospitalization were excluded from the study.
Patients were divided into statin users and nonusers. Those taking statins for less than 2 months before hospital admission were assigned to the control group. "This is because C-reactive protein levels stabilize at around 8 weeks, showing peak anti-inflammatory effects," Dr. Khemasuwan commented in an interview with Medscape Pulmonary Medicine after he presented his findings. Overall, 26% (n?= 194) of patients in the study were receiving statins.
The incidence of VTE in the study population as a whole was 18% (n?= 132); among statin users the incidence was 8% (n?= 16), and in the control group it was 21% (n?= 116; odds ratio [OR], 0.33; 95% CI, 0.192 – 0.578; P?< .001).
When analyzed according to risk factors for VTE, such as smoking, metastatic cancer, current use of chemotherapy, immobilization, and use of aspirin, the results "yielded the same results," Dr. Khemasuwan reported.
"Even including all the confounding factors I could find, the risk reduction was still significant," he said. “And even though aspirin doesn’t help reduce the risk of VTE, as reported earlier this year, statins do help.”
"A lot of doctors would stop giving statins to cancer patients because they think the risks may outweigh the benefits..., but this may be another indication for statins in the future," if the findings are confirmed, he commented. Statins may reduce the risk for VTE in this patient population, he said.
"This makes a lot of sense, especially because of the pleiotrophic effects of statins," David D. Gutterman, MD, FCCP, senior associate dean of research at the Medical College of Wisconsin at Milwaukee, and past chair of the Health and Science Policy Committee of the American College of Chest Physicians, told Medscape Pulmonary Medicine. Dr. Gutterman moderated the panel at which the Albert Einstein Medical Center findings were announced.
"The endothelial effects of statins may be more important than the anti-inflammatory effects. The effects occurring on the venous side of the equation may be as important as those that are occurring on the arterial side," Dr. Gutterman pointed out.
"It would be interesting to do a similar study in a different population at high risk," Dr. Gutterman commented to Dr. Khemasuwan, "and it may be easier to do this while you're still a resident!"
Neither Dr. Khemasuwan nor Dr. Gutterman have disclosed any relevant financial relationships.
CHEST 2008: American College of Chest Physicians 74th Annual Scientific Assembly: Abstract AS2202. Presented October 27, 2008.
[ 本帖最後由 goodcat1111 於 2008-11-5 23:13 編輯 ] |
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