PPI和胃癌:是否存在因果关系?
Pellegrino Crafa1, Marilisa Franceschi2, Kryssia Isabel Rodriguez-Castro3
1. pellegrino.crafa@unipr.it.
Acta bio-medica : Atenei Parmensis
|June 16, 2023
概括
长期使用质子抑制剂 (PPI) 与胃癌没有因果关系. 研究中的方法学偏见,如反向因果关系和混因素,掩盖了潜在的关系.
科学领域:
- 胃肠病学 胃肠病学
- 药学流行病学 药学流行病学
- 在瘤学瘤学.
背景情况:
- 盐酸在胃生理学中起着至关重要的作用.
- 发展了组胺H2受体对抗剂 (例如cimetidine) 和质子抑制剂 (PPI) 以减少酸的产生.
- 人们对长期的抑制酸性疗法与胃癌风险之间的潜在联系表示担忧.
研究的目的:
- 批判性地评估有关长期质子抑制剂 (PPI) 治疗与胃癌风险之间的关系的科学文献.
- 识别和分析现有研究中可能影响结论的潜在方法偏差.
主要方法:
- 现有文献的审查,包括元分析和基于人口的研究,检查长期PPI使用和胃癌之间的关联.
- 对收集病例的方法限制的分析,包括H. pylori状态,缩性胃炎,肠道代谢和反向因果关系.
- 对药物流行病学研究的评估,重点关注潜在的偏见.
主要成果:
- 在文献中,关于长期使用PPI和胃癌之间的关联存在相互矛盾的结果.
- 在相关研究中普遍存在显著的方法偏差,包括采样错误和对混因素 (H. pylori,胃炎) 的不充分评估.
- 反向因果关系的现象,即对包括胃瘤在内的患有先前疾病的患者处方PPI,可能会扭曲结果.
结论:
- 当前文献数据,当调整以确定方法偏差时,不支持长期PPI治疗和胃癌发病之间的因果关系.
- 需要进一步的严格研究和强大的方法来最终澄清任何潜在的关联.
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