儿童哮喘应用ICS后青光眼发生率降低：一项队列研究
2018/01/15
摘要
在所有哮喘治疗抗炎药物中，皮质激素最为有效。已有研究提示口服皮质激素对于眼球内压和晶状体浑浊度有影响，但ICS对于儿童患者的影响尚不明确。因此，本研究通过全国队列数据库分析应用ICS儿童哮喘患者的青光眼发生情况。研究从台湾2000年国家健康保险研究数据库随机提取100万人的样本。研究队列纳入5380名在6岁前确诊断为哮喘（ICD9:493.X）的患者。所有受试者随访至2011年12月。应用Cox风险模型评价ICS应用与青光眼的相关性。在整个随访期中，5380名受试者中1232名患者应用ICS，而4148名患者则没有。应用ICS组患者青光眼发病率更低，与对照组相比，其风险比下降52%[HR=0.52, 95%CI:0.28-0.96]. 在所有合并症评估中，白内障与哮喘儿童青光眼的发生呈正相关（HR=8.22，95%CI=2.59-26.12）。本研究既是首次更是为ICS治疗组青光眼发生率低于非ICS治疗组提供了强有力的依据。而哮喘合并白内障患儿高风险组则需要请眼科医生协助会诊。
Decreased incidence of glaucoma in children with asthma using inhaled corticosteroid: a cohort study.
Oncotarget. 2017 Nov 1;8(62):105463-105471. doi: 10.18632/oncotarget.22252. eCollection 2017 Dec 1.
Chang LS, Lee HC, Tsai YC, Shen LS, Li CL, Liu SF, Kuo HC.
Abstract
Among the anti-inflammatory medications used for treating asthma, corticosteroids are the most effective. The effects of orally administered corticosteroids on intraocular pressure and lens opacity have been well defined, but the influence of inhaled corticosteroids (ICS) on children has yet to be clearly explained. Therefore, we used a nationwide cohort database to investigate glaucoma in childhood asthma patients using ICS. We analyzed a dataset of 1,000,000 randomly sampled individuals from Taiwan's 2000 National Health Insurance Research Database. The study cohort included 5,380 patients who were first diagnosed with asthma (ICD9: 493.X) diagnosis when they were six years old or younger. All subjects were followed through December 2011. We applied Cox's proportional hazard model to determine whether ICS use has a correlation with glaucoma. Of the 5,380 patients enrolled in this study, we identified 1,232 patients who had used ICS and 4,148 patients who had no history of ICS administration throughout the follow-up period. The prevalence of glaucoma was significantly lower in patients using ICS, with a 0.52-fold decreased risk of developing glaucoma in comparison to the control group [adjusted hazard ratio (HR) 0.52, 95% confidence interval (CI) 0.28∼0.96]. Among the evaluated comorbidities, cataract was positively associated with glaucoma in asthma children (adjusted HR 8.22; 95% CI = 2.59∼26.12). This study provides not only the first but also strong evidence that the glaucoma incidence in the ICS group is lower than that in the non-ICS group in children with asthma. Further consultation with an ophthalmologist regarding the high-risk group of asthma children with cataracts is necessary.
在所有哮喘治疗抗炎药物中，皮质激素最为有效。已有研究提示口服皮质激素对于眼球内压和晶状体浑浊度有影响，但ICS对于儿童患者的影响尚不明确。因此，本研究通过全国队列数据库分析应用ICS儿童哮喘患者的青光眼发生情况。研究从台湾2000年国家健康保险研究数据库随机提取100万人的样本。研究队列纳入5380名在6岁前确诊断为哮喘（ICD9:493.X）的患者。所有受试者随访至2011年12月。应用Cox风险模型评价ICS应用与青光眼的相关性。在整个随访期中，5380名受试者中1232名患者应用ICS，而4148名患者则没有。应用ICS组患者青光眼发病率更低，与对照组相比，其风险比下降52%[HR=0.52, 95%CI:0.28-0.96]. 在所有合并症评估中，白内障与哮喘儿童青光眼的发生呈正相关（HR=8.22，95%CI=2.59-26.12）。本研究既是首次更是为ICS治疗组青光眼发生率低于非ICS治疗组提供了强有力的依据。而哮喘合并白内障患儿高风险组则需要请眼科医生协助会诊。
（上海交通大学医学院附属瑞金医院呼吸与危重症医学科 周剑平 万欢英 摘译）
（Oncotarget. 2017 Nov 1;8(62):105463-105471. doi: 10.18632/oncotarget.22252. eCollection 2017 Dec 1.）
（Oncotarget. 2017 Nov 1;8(62):105463-105471. doi: 10.18632/oncotarget.22252. eCollection 2017 Dec 1.）
Decreased incidence of glaucoma in children with asthma using inhaled corticosteroid: a cohort study.
Oncotarget. 2017 Nov 1;8(62):105463-105471. doi: 10.18632/oncotarget.22252. eCollection 2017 Dec 1.
Chang LS, Lee HC, Tsai YC, Shen LS, Li CL, Liu SF, Kuo HC.
Abstract
Among the anti-inflammatory medications used for treating asthma, corticosteroids are the most effective. The effects of orally administered corticosteroids on intraocular pressure and lens opacity have been well defined, but the influence of inhaled corticosteroids (ICS) on children has yet to be clearly explained. Therefore, we used a nationwide cohort database to investigate glaucoma in childhood asthma patients using ICS. We analyzed a dataset of 1,000,000 randomly sampled individuals from Taiwan's 2000 National Health Insurance Research Database. The study cohort included 5,380 patients who were first diagnosed with asthma (ICD9: 493.X) diagnosis when they were six years old or younger. All subjects were followed through December 2011. We applied Cox's proportional hazard model to determine whether ICS use has a correlation with glaucoma. Of the 5,380 patients enrolled in this study, we identified 1,232 patients who had used ICS and 4,148 patients who had no history of ICS administration throughout the follow-up period. The prevalence of glaucoma was significantly lower in patients using ICS, with a 0.52-fold decreased risk of developing glaucoma in comparison to the control group [adjusted hazard ratio (HR) 0.52, 95% confidence interval (CI) 0.28∼0.96]. Among the evaluated comorbidities, cataract was positively associated with glaucoma in asthma children (adjusted HR 8.22; 95% CI = 2.59∼26.12). This study provides not only the first but also strong evidence that the glaucoma incidence in the ICS group is lower than that in the non-ICS group in children with asthma. Further consultation with an ophthalmologist regarding the high-risk group of asthma children with cataracts is necessary.
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重症过敏性哮喘接受奥玛珠单抗治疗伴发自身免疫性2型多内分泌综合征
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空气污染物和哮喘患者就诊：环境影响因素
