JAMA Dermatol :螺内酯真的会导致癌症风险增加吗?

2022-03-16 医路坦克 MedSci原创

螺内酯是一种合成的17-内酯类固醇,对雄激素和孕激素受体也有拮抗作用。本文综合了关于螺内酯使用的癌症风险的证据以确定曾接受螺内酯治疗的患者中癌症,特别是乳腺癌和前列腺癌的共同发生率。

     螺内酯是一种合成的17-内酯类固醇,是一种保钾利尿剂,对雄激素和孕激素受体也有拮抗作用。美国食品和药物管理局(FDA)批准它用于治疗心力衰竭、水肿和腹水、高血压和原发性醛固酮增多症。此外,螺内酯由于其抗雄激素特性,经常被用作治疗痤疮、汗腺炎、雄激素性脱发和多毛症的非标准治疗方法。特别是对于女性痤疮,螺内酯已显示出作为一种可以减少对口服抗生素依赖的有效选择的前景。

    螺内酯也经常被用作性别治疗的一部分,它被包括在内分泌协会指南中,作为变性人妇女(男性转变为女性)激素方案的一部分。对于寻求女性身体特征的变性人妇女,抗雄激素,如螺内酯,可以减少肌肉肥大和男性体毛生长,诱导皮肤软化,改变身体脂肪分布,并导致睾丸收缩。对于变性人男性,螺内酯可以治疗荷尔蒙痤疮和雄激素源性脱发。

    然而,螺内酯带有FDA关于可能致癌的官方警告。这一警告主要是基于动物研究,使用的剂量高达人类剂量的150倍,并在肝脏、睾丸和乳腺腺瘤的发生中被发现。几项观察性研究尚未证实在典型的临床实践中使用螺内酯时存在这种风险。此外,由于前列腺癌是一种雄激素敏感的肿瘤,使用螺内酯可能与前列腺癌的发病率降低有关。鉴于这一官方警告以及螺内酯使用与癌症之间潜在联系的不确定性,这项研究的目的是进行一项系统的综述和荟萃分析,以综合关于螺内酯使用的癌症风险的证据。确定曾接受螺内酯治疗的患者中癌症,特别是乳腺癌和前列腺癌的共同发生率。

    对PubMed、Cochrane Library、Embase和Web of Science进行了从最初到2021年6月11日的搜索。包括报告了接触螺内酯的18岁及以上的男性和女性发生癌症的研究。两位独立评审员(K.B.和H.H.)选择研究,提取数据,并使用纽卡斯尔-渥太华量表评估偏倚的风险。研究采用随机效应荟萃分析方法进行综合。主要结果和测量食管癌发生情况,重点是乳腺癌和前列腺癌。

    有7项研究符合资格标准,样本量从18035到230万不等,总人口4528332人(平均年龄62.6-72.0岁;在没有按性别分层的研究中,女性占17.2%-54.4%)。所有研究都被认为具有低偏倚风险。在使用螺内酯和乳腺癌风险之间没有观察到统计学意义上的关联(风险比[RR],1.04;95%可信区间,0.86-1.22;证据的确定性很低)。螺内酯的使用与前列腺癌风险的降低有关(RR,0.79;95%CI,0.68-0.90;证据的确定性很低)。使用螺内酯与卵巢癌(RR,1.52;95%CI,0.84-2.20;证据可信度很低)、膀胱癌(RR,0.89;95%CI,0.71-1.07;证据确定性很低)、肾癌(RR,0.96;95%CI,0.85-1.07;证据确定性低)、胃癌(RR,1.02;95%CI,0.80-1.24;证据确定性低)或食道癌(RR,1.09;95%可信区间为0.91~1.27;证据确定性低)。

    研究表明螺内酯的使用与癌症风险的显著增加无关,而与前列腺癌风险的降低有关,即螺内酯是治疗痤疮、汗腺炎、雄激素性脱发和多毛症患者的重要治疗方法,不太可能与癌症风险的显著增加相关。然而,证据的可信度较低很低。未来需要进一步研究,特别是在不同人群中,如年轻人和有痤疮或多毛症的人。

文献来源:Bommareddy K,  Hamade H,  Lopez-Olivo MA,Association of Spironolactone Use With Risk of Cancer: A Systematic Review and Meta-analysis.JAMA Dermatol 2022 Feb 09;

 

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    2022-03-16 jiazhoudexue

    螺内酯是临床上降压的好帮手!该文并无明确支持的证据,仅仅基于动物实验且使用人类剂量的150倍,这样的结果有意义吗?

    0

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    2022-03-16 zy&kt

    学习了,谢谢!

    0

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    2022-03-16 rabiby

    螺内酯的副作用还需长期的临床观察确定

    0

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    2022-03-16 jambiya

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