使用β-肾上腺素能受体激动剂系统治疗可以降低小腿溃养的危险性

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Beta-Adrenergic Receptor Agents May Protect Against Venous Leg Ulcers

NEW YORK (Reuters Health) Oct 15 - Systemic treatment with beta-adrenergic receptor agonists appears to reduce the risk of venous leg ulcers, according to results of a retrospective cohort study published in the Archives of Dermatology for October.

Moreover, there may be a subset of patients using beta-adrenergic receptor antagonists who are also protected against development of the chronic wounds, lead author Dr. David J. Margolis at University of Pennsylvania in Philadelphia, and his associates suggest.

The researchers previously reported \"unexplainable associations\" between diseases treated with beta-adrenergic agents and the onset of a venous leg ulcer. They also point out that \"there is strong laboratory evidence\" supporting protective effects of these drugs.

To further explore these issues, the investigators obtained data from the British General Practice Research Database for individuals treated between 1987 and 2002. Included were data for nearly 415,000 individuals, ages 49 to 73 years.

Analysis revealed that venous leg ulcers occurred in 15.5% of those exposed to beta-agonists versus 18.4% of non-exposed persons. In analyses adjusted for sex, age, and history of asthma and glucocorticoid use, the odds ratio for developing a venous leg ulcer was 0.44 for those treated with beta-adrenergic receptor agonist use compared with controls.

In patients treated with beta-blockers, venous leg ulcers occurred in 18.2% of those exposed and 17.7% of those not exposed. After adjusting for sex, age, history of MI, hypertension, angina, and congestive heart failure, the corresponding odds ratio was 1.04. However, the authors note, a propensity score model suggests that a subset of patients were protected against venous leg ulcers.

Based on previous research, Dr. Margolis and his associates theorize that the protective effect of beta-adrenergic receptor agonists could be mediated by increased migration and proliferation of dermal fibroblasts, enhanced angiogenesis and anti-inflammatory effects, all of which could enhance the wound repair process.

They also speculate that the variable effects of beta antagonists may be caused by genetic polymorphisms in the beta-adrenergic receptor.

Nevertheless, Dr. Margolis's team cautions that \"the evidence in this study should not be used as a rationale for treatment of venous leg ulcers with beta-adrenergic receptor agents but should be compelling for the consideration of a randomized clinical trial.\"