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目的探究血管紧张素受体阻滞剂的使用是否与癌症风险相关。设计将用血管紧张素受体阻滞剂与用血管紧张素转换酶(ACE)抑制剂者的患癌风险做队列研究。用Cox模型校正年龄、性别、体质指数、糖尿病及使用二甲双胍或胰岛素、高血压、心力衰竭、使用他汀类药物、社会经济状况、饮酒、吸烟和历年,用时间更新变异做影响探究。将主要分析中的最强风险决定因素加入卜瓦松模型来预测绝对风险变化。设施英国初级保健诊所为全科医学研究数据库提供数据。参试者治疗至少1年的血管紧张素受体阻滞剂或ACE抑制剂新近使用者377 649例。主要结果测量用血管紧张素受体阻滞剂的使用及使用累积持续时间来校正所有癌症或主要部位某些癌症(乳腺、肺、结肠、前列腺癌)危险比。结果随访中位时间为开始治疗后4.6年;观察癌症20 203例。尚无证据表明那些曾暴露于血管紧张素受体阻滞剂者患癌风险增加〔校正危险比=1.03,95%CI(0.99,1.06),P=0.10〕。但乳腺癌及前列腺癌风险增加〔校正危险比=1.11,95%CI(1.01,1.21),P=0.02;校正危险比=1.10,95%CI(1.00,1.20),P=0.04〕,在基线高风险者中每1 000人年增加病例分别为0.5和1.1。较长治疗持续时间似乎与高风险不相关(P>0.15)。患肺癌风险减少〔校正危险比=0.84,95%CI(0.75,0.94)〕,但对结肠癌无影响〔校正危险比=1.02,95%CI(0.91,1.16)〕。结论血管紧张素受体阻滞剂的使用与总癌症风险增加不相关。乳腺癌及前列腺癌增加的绝对风险较小,与治疗持续时间关联不足意味着不能排除无因果关系的解释。
Aim To investigate whether the use of angiotensin receptor blockers is associated with cancer risk. The design will use a combination of angiotensin receptor blockers and angiotensin converting enzyme (ACE) inhibitors to study the risk of cancer. Using Cox models to correct for age, gender, body mass index, diabetes mellitus and metformin or insulin, hypertension, heart failure, statins, socioeconomic status, drinking, smoking, The most risky determinants of the main analysis are added to the Boisson model to predict absolute risk changes. Facility British Primary Care Clinics provide data for the GMRS database. Participants treated 377,649 recent users of angiotensin receptor blockers or ACE inhibitors for at least 1 year. Main Outcome Measures The use of angiotensin receptor blockers and the cumulative duration of use corrects for the hazard ratio of certain cancers (breast, lung, colon, prostate cancer) in all cancers or major sites. Results The median follow-up time was 4.6 years after the start of treatment; 20,203 cases of cancer were observed. There is no evidence that those who had been exposed to angiotensin receptor blockers had an increased risk of cancer (adjusted hazard ratio = 1.03, 95% CI (0.99, 1.06), P = 0.10). However, the risk of breast cancer and prostate cancer increased (corrected hazard ratio = 1.11, 95% CI 1.01, 1.21, P = 0.02; adjusted hazard ratio = 1.10, 95% CI 1.00, 1.20, P 0.04) The increase in cases of high-risk people per 1,000 person-years was 0.5 and 1.1, respectively. Longer treatment duration seems to be unrelated to high risk (P> 0.15). Risk of lung cancer was reduced (adjusted for hazard ratio = 0.84, 95% CI (0.75, 0.94)] but not for colon cancer (adjusted for hazard ratio = 1.02, 95% CI, 0.91, 1.16). Conclusion The use of angiotensin receptor blockers is not associated with an increased overall cancer risk. The absolute risk of breast and prostate cancer increases is small, and the lack of association with duration of treatment means that no causal explanation can not be ruled out.