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秋水仙碱用于慢性冠心病患者
Colchicine in Patients with Chronic Coronary Disease


Stefan M. Nidorf ... 心脑血管疾病 • 2020.11.05
相关阅读
• 心肌梗死后应用小剂量秋水仙碱的疗效和安全性 • 急性心肌梗死 • 动脉粥样硬化斑块的愈合

八年磨剑,初显锋芒,秋水仙碱或成冠心病抗炎治疗“利刃”

 

余淼,程翔*

华中科技大学同济医学院附属协和医院心血管内科

*通讯作者

 

早在1858年Virchow就提出动脉粥样硬化(atherosclerosis,AS)是一种由胆固醇引起的慢性炎症状态,然而炎症网络的复杂性和炎症反应的个体差异性阻碍了冠心病抗炎治疗的临床进展。

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摘要


背景

近期一项试验表明,秋水仙碱的抗炎作用可降低近期心肌梗死患者发生心血管事件的风险,但慢性冠心病患者的上述风险降低证据有限。

 

方法

在一项随机、对照、双盲试验中,我们将慢性冠心病患者分配接受每日一次0.5 mg秋水仙碱或匹配安慰剂治疗。主要终点是由心血管原因死亡、自发性(非手术相关)心肌梗死、缺血性卒中或因缺血实施冠状动脉血运重建构成的复合终点。关键次要终点是由心血管原因死亡、自发性心肌梗死或缺血性卒中构成的复合终点。

 

结果

共计5,522例患者接受了随机分组,其中2,762人被分配到秋水仙碱组,2,760人被分配到安慰剂组。中位随访时间为28.6个月。秋水仙碱组和安慰剂组分别有187例患者(6.8%)和264例患者(9.6%)发生了主要终点事件(发生率,每100人-年2.5起 vs. 3.6起事件;风险比,0.69;95%置信区间[CI],0.57~0.83;P<0.001)。秋水仙碱组和安慰剂组分别有115例患者(4.2%)和157例患者(5.7%)发生了关键次要终点事件(发生率,每100人-年1.5起 vs. 2.1起事件;风险比,0.72;95% CI,0.57~0.92;P=0.007)。在秋水仙碱组中,自发性心肌梗死或因缺血实施冠状动脉血运重建(复合终点)、心血管原因死亡或自发性心肌梗死(复合终点)、因缺血实施冠状动脉血运重建及自发性心肌梗死的发生率也显著低于安慰剂组。秋水仙碱组的非心血管原因死亡率高于安慰剂组(发生率,每100人-年0.7起 vs. 0.5起事件;风险比,1.51;95% CI,0.99~2.31)。

 

结论

此项纳入慢性冠心病患者的随机试验表明,每日一次服用0.5 mg秋水仙碱的患者发生心血管事件的风险显著低于服用安慰剂的患者(由澳大利亚国家健康医学研究委员会[National Health Medical Research Council of Australia]等资助,LoDoCo2在澳大利亚新西兰临床试验注册系统[Australian New Zealand Clinical Trials Registry]注册号为12614000093684)。





作者信息

Stefan M. Nidorf, M.D., Aernoud T.L. Fiolet, M.D., Arend Mosterd, M.D., John W. Eikelboom, M.D., Astrid Schut, M.Sc., Tjerk S.J. Opstal, M.D., Salem H.K. The, M.D., Xiao-Fang Xu, M.D., Mark A. Ireland, M.D., Timo Lenderink, M.D., Donald Latchem, M.D., Pieter Hoogslag, M.D., Anastazia Jerzewski, M.D., Peter Nierop, M.D., Alan Whelan, M.D., Randall Hendriks, M.D., Henk Swart, M.D., Jeroen Schaap, M.D., Aaf F.M. Kuijper, M.D., Maarten W.J. van Hessen, M.D., Pradyot Saklani, M.D., Isabel Tan, M.D., Angus G. Thompson, M.D., Allison Morton, M.D., Chris Judkins, M.D., Willem A. Bax, M.D., Maurits Dirksen, M.D., Marco Alings, M.D., Graeme J. Hankey, M.D., Charley A. Budgeon, Ph.D., Jan G.P. Tijssen, Ph.D., Jan H. Cornel, M.D., and Peter L. Thompson, M.D. for the LoDoCo2 Trial Investigators*
From GenesisCare Western Australia (S.M.N., X.-F.X., M.A.I., D.L., A.W., R.H., P.S., I.T., A.G.T., A. Morton, P.L.T.), the Heart and Vascular Research Institute (S.M.N., P.L.T.) and the Department of Neurology (G.J.H.), Sir Charles Gairdner Hospital, and the Faculty of Health and Medical Sciences (G.J.H., P.L.T.) and the School of Population and Global Health (C.A.B.), University of Western Australia, Perth, the Department of Cardiology, Fiona Stanley Hospital, Murdoch, WA (C.J.), and the Harry Perkins Institute of Medical Research, Nedlands, WA (P.L.T.) — all in Australia; the Dutch Network for Cardiovascular Research (A.T.L.F., A. Mosterd, A.S., S.H.K.T., T.L., P.H., A.J., P.N., H.S., J.S., A.F.M.K., M.W.J.H., M.D., M.A., J.H.C.), the Netherlands Heart Institute (A.T.L.F.), and the Department of Cardiology (A.T.L.F.) and the Julius Center for Health Sciences and Primary Care (A. Mosterd, M.A.), University Medical Center Utrecht, Utrecht, the Department of Cardiology, Meander Medical Center, Amersfoort (A. Mosterd), the Departments of Cardiology (T.S.J.O., M.D., J.H.C.) and Internal Medicine (W.A.B.), Northwest Clinics, Alkmaar, the Department of Cardiology, Radboud University Medical Center, Nijmegen (T.S.J.O., J.H.C.), the Department of Cardiology, Treant Zorggroep, Hoogeveen, Emmen, and Stadskanaal (S.H.K.T.), the Department of Cardiology, Zuyderland Medical Center, Heerlen and Sittard (T.L.), the Department of Cardiology, Isala Diaconessenhuis, Meppel (P.H.), the Department of Cardiology, Gelre Hospitals, Apeldoorn (A.J.), the Department of Cardiology, Franciscus Hospital (P.N.), and Cardialysis (J.G.P.T.), Rotterdam, the Department of Cardiology, D&A Research and Genetics, Sneek (H.S.), the Department of Cardiology, Amphia and Breda (J.S., M.A.), the Department of Cardiology, Spaarne Hospital, Haarlem and Hoofddorp (A.F.M.K.), the Department of Cardiology, Green Heart Hospital, Gouda (M.W.J.H.), and the Department of Cardiology, Amsterdam UMC, Amsterdam (J.G.P.T.) — all in the Netherlands; and the Department of Medicine, McMaster University, Hamilton, ON, Canada (J.W.E.). Address reprint requests to Dr. Nidorf at GenesisCare, 3/140 Mounts Bay Rd., Perth 6000, WA, Australia, or at smnidorf@gmail.com; or to Dr. Mosterd at the Department of Cardiology, Meander Medical Center, P.O. Box 1502, 3800 BM Amersfoort, the Netherlands, or at a.mosterd@meandermc.nl. *A complete list of the investigators in the LoDoCo2 trial is provided in the Supplementary Appendix, available at NEJM.org.

 

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