肺癌是COPD患者的常见死因之一。为了探讨吸入性皮质类固醇治疗是否有助于降低COPD患者发生肺癌的危险，在一项包含10474例罹患 COPD的美国退伍军人的研究中，研究人员David H. Au等人进行了为期3.8年（中位数）的追踪调查。
在这项研究中，经过调整年龄、吸烟状况、吸烟强度、过去之非肺癌恶性肿瘤病史、基础疾病和支气管扩张剂治疗情况后，发现接受吸入性皮质类固醇治疗的COPD患者中，肺癌发病危险随着吸入性皮质类固醇治疗剂量的增加，而呈现出剂量效应地降低。吸入性皮质类固醇剂量<1200 μg/日的受试者，发生肺癌的风险比为1.13，而≥1200 μg/日者为0.39。
这项研究结果显示，对于COPD患者而言，吸入性皮质类固醇可能具有潜在的预防肺癌效果。不过这只是初步结果而已，还需要更多大规模研究来验证这项结果。
本研究发表于2007年4月出刊的American Journal of Respiratory and Critical Care Medicine中。
(资料来源 : Bio.com)
部分英文原文：
American Journal of Respiratory and Critical Care Medicine Vol 175. pp. 712-719, (2007)Original Article
Inhaled Corticosteroids and Risk of Lung Cancer among Patients with Chronic Obstructive Pulmonary Disease
Tanyalak Parimon1,*, Jason W. Chien1,2,*, Chris L. Bryson1,3, Mary B. McDonell3, Edmunds M. Udris1,2 and David H. Au1,3
1 Department of Medicine, University of Washington, Seattle, Washington; 2 Clinical Research Division, Fred Hutchison Cancer Research Center, Seattle, Washington; and 3 Health Services Research and Development, VA Puget Sound Health Care System, Seattle, Washington
Correspondence and requests for reprints should be addressed to David H. Au, M.D., M.S., Health Services Research and Development (MS152), VA Puget Sound Health Care System, 1100 Olive Way, Suite 1400, Seattle, WA 98101. E-mail: dau@u.washington.edu
Rationale and Objectives: Lung cancer is a frequent cause of death among patients with chronic obstructive pulmonary disease (COPD). We examined whether the use of inhaled corticosteroids among patients with COPD was associated with a decreased risk of lung cancer.
Methods: We performed a cohort study of United States veterans enrolled in primary care clinics between December 1996 and May 2001. Participants had received treatment for, had an International Classification of Disease, 9th edition, diagnosis of, or a self-reported diagnosis of COPD. Patients with a history of lung cancer were excluded. To be exposed, patients must have been at least 80% adherent to inhaled corticosteroids. We used Cox regression models to estimate the risk of cancer and adjust for potential confounding factors.
Findings: We identified 10,474 patients with a median follow-up of 3.8 years. In comparison to nonusers of inhaled corticosteroids, adjusting for age, smoking status, smoking intensity, previous history of non–lung cancer malignancy, coexisting illnesses, and bronchodilator use, there was a dose-dependent decreased risk of lung cancer associated with inhaled corticosteroids (ICS dose < 1,200 µg/d: adjusted HR, 1.3; 95% confidence interval, 0.67–1.90; ICS dose 1,200 µg/d: adjusted HR, 0.39; 95% confidence interval, 0.16–0.96). Changes in cohort definitions had minimal effects on the estimated risk. Analyses examining confounding by indication suggest biases in the opposite direction of the described effects.
Interpretation: Results suggest that inhaled corticosteroids may have a potential role in lung cancer prevention among patients with COPD. These initial findings require confirmation in separate and larger cohorts.
Key Words: chronic obstructive pulmonary disease • pharmacoepidemiology • lung cancer • adherence
