质子抑制剂和基因素2受体对手的使用以及维生素B12缺乏症
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Jameson R Lam1, Jennifer L Schneider, Wei Zhao
1Division of Research, Kaiser Permanente, Oakland, California.
JAMA
|December 12, 2013
概括
长期使用质子抑制剂 (PPI) 和组胺2受体对抗剂 (H2RAs) 显著增加维生素B12缺乏症的风险. 医疗保健提供者在开处方这些常见的抑制酸性的药物时应该考虑这种风险.
科学领域:
- 胃肠病学 胃肠病学
- 临床药理学 临床药理学
- 营养科学 营养科学
背景情况:
- 质子抑制剂 (PPI) 和组织素2受体对抗剂 (H2RAs) 降低胃酸的产生.
- 这种减少可能会损害维生素B12的吸收,可能导致缺乏.
- 对于这些药物对维生素B12水平的长期影响,存在有限的大规模人口数据.
研究的目的:
- 调查使用PPI和H2RA与维生素B12缺乏症之间的关联.
- 为了在一个大规模的,以社区为基础的美国人口中评估这一关联.
主要方法:
- 一项病例控制研究使用了来自北加利福尼亚州Kaiser Permanente的数据.
- 25,956名发生维生素B12缺乏症的患者与184,199名没有缺乏症的对照人群进行了比较.
- 电子健康记录被用于确定药物暴露 (PPI/H2RAs超过2年) 和维生素B12缺乏症诊断.
主要成果:
- 长期使用 (≥2年) PPI与维生素B12缺乏症的风险增加1.65倍相关 (OR,1.65;95% CI,1.58-1.73).
- 长期使用 (≥2年) 的H2RA与维生素B12缺乏症的风险增加1.25倍相关 (OR,1.25;95% CI,1.17-1.34).
- 较高的PPI剂量 (>1.5片/天) 与较低剂量相比,与维生素B12缺乏症的相关性更强.
结论:
- 无论是PPI还是H2RA使用,特别是长期使用,都与维生素B12缺乏症有显著的关联.
- 临床医生在开处方这些抑制酸的药物时,应权衡维生素B12吸收不良的益处与风险.
- 需要进一步考虑长期治疗患者的维生素B12水平监测.
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