背景：越来越多的证据表明质子泵抑制剂增加了失代偿期肝硬化患者的感染风险。目的：为了评估质子泵抑制剂增加失代偿期肝硬化感染概率的程度。方法：我们用美国退伍军人健康管理局的数据进行了一项回顾性倾向匹配设计。2001年至2009年的失代偿期肝硬化患者包括在内。失代偿期肝硬化首次应用PPI的与没有应用抑酸药的比例为1:1，均为1268人。我们观察的结果为严重感染，即被定义为住院治疗的感染。被分为抑酸剂相关（自发性腹膜炎，菌血症，难辨梭状芽孢杆菌，肺炎等）和非抑酸剂相关两组。结果：随时间变化的Cox模型被用来评估调整后的危险比和可信区间。我们对H2受体拮抗剂进行了相似的分析。过半的失代偿期肝硬化患者是首次应用抑酸剂的，包括45.6%应用PPI的和5.9%应用H2受体拮抗剂的。在使用PPI的倾向匹配分析中，25.3%发展成为严重感染，在H2受体拮抗剂分析中，25.9%发展成为严重感染。结论：使用PPI的患者比不适用抑酸剂的患者感染发生的速度快。对于抑酸相关的严重感染，严重感染发生概率，使用PPI的是不使用的1.75倍。H2受体拮抗剂的分析结果无统计学意义。在失代偿期肝硬化患者中，PPI增加了严重感染的发生率，而不是H2受体拮抗剂
吉林大学第一医院肝胆胰内科 祁亚宾 胡玉琳 摘译
本文首次发表于[Aliment. Pharmacol. Ther., 2012,11]
本文首次发表于[Aliment. Pharmacol. Ther., 2012,11]
Proton pump inhibitors are associated with a high rate of serious infections in veterans with decompensated cirrhosis
Background There is increasing evidence that proton pump inhibitors (PPIs) increase the rate of infections in patients with decompensated cirrhosis. Aims To estimate the extent to which proton pump inhibitors (PPIs) increase the rate of infections among patients with decompensated cirrhosis. METHODS We conducted a retrospective propensity-matched new user design using US Veterans Health Administration data. Only decompensated cirrhotic patients from 2001 to 2009 were included.New PPI users after decompensation (n = 1268) were 1:1 matched to those who did not initiate gastric acid suppression. Serious infections, defined as infections associated with a hospitalisation, were the outcomes. These were separated into acid suppression-related (SBP, bacteremia, Clostridium difficile and pneumonia) and non-acid suppression-related. RESULTS Time-varying Cox models were used to estimate adjusted hazard ratios (HR) and 95% CIs of serious infections. Parallel analyses were conducted with H2 receptor antagonists(H2RA). More than half of persons with decompensated cirrhosis were new users of gastric acid suppressants, with most using PPIs (45.6%) compared with H2RAs (5.9%). In the PPI propensity-matched analysis, 25.3% developed serious infections and 25.9% developed serious infections in the H2RA analysis. CONCLUSIONS PPI users developed serious infections faster than nongastric acid suppression users (adjusted HR: 1.66; 95% CI: 1.31-2.12). For acid suppression-related serious infections, PPI users developed the outcome at a rate 1.75 times faster than non-users (95% CI: 1.32-2.34). The H2RA findings were not statistically[stə'tɪstɪkli] significant。(HR serious infections: 1.59; 95% CI: 0.80-3.18; HR acid suppression-related infections: 0.92; 95% CI: 0.31-2.73). Among patients with decompensated cirrhosis, PPIs but not H2RAs increase the rate of serious infections.
