高剂量质子抑制剂治疗与肝硬化患者的死亡率较高有关:一个多中心研究
Jun Sik Yoon1, Ji Hoon Hong2, Soo Young Park3
1Department of Internal Medicine, Busan Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea.
Alimentary pharmacology & therapeutics
|February 23, 2024
概括
高剂量质子抑制剂 (PPI) 在肝硬化患者的使用与更糟糕的结果有关. 这包括增加的死亡率和并发症,如肝脏脑病变,SBP,HRS和出血.
科学领域:
- 肝病学 肝病学是一种肝病学.
- 胃肠病学 胃肠病学
- 临床药理学 临床药理学
背景情况:
- 质子抑制剂 (PPI) 通常被处方给肝硬化患者.
- 抗胰岛素抗胰岛素剂量对肝硬化患者预后的影响仍然是研究领域.
研究的目的:
- 研究使用质子抑制剂 (PPI) 与肝硬化患者的预后之间的关联.
- 为了确定高剂量的PPI治疗是否会影响整体生存率和肝硬化并发症的发展.
主要方法:
- 进行了一项多中心回顾性队列研究,对1485名肝硬化患者进行了研究,这些患者患有肝脏脑病 (HE).
- 患者被分为高剂量的PPI (平均定义每日剂量[mDDD]≥0.5) 和没有或低剂量的PPI (mDDD<0.5) 组.
- 评估的结果包括整体存活率和并发症,如复发性HE,自发性细菌腹膜炎 (SBP),肝综合征 (HRS) 和胃肠道出血,分析与或没有倾向性得分匹配 (PSM).
主要成果:
- 高剂量的PPI使用独立地与显著更高的死亡风险相关 (aHR=1.71,p<0.001),这种联系在PSM后持续 (aHR=1.90,p<0.001).
- 高剂量的PPI也是复发性HE的独立风险因素 (PSM前aHR=2.04,p<0.001;PSM后aHR=2.16,p<0.001).
- 在高剂量PPI使用和SBP风险增加 (PSM前aHR=1.87,p<0.001;PSM后aHR=1.76,p=0.002) 和胃肠道出血 (PSM前aHR=1.46,p=0.006;PSM后aHR=1.74,p<0.001) 之间发现了显著的关联.
结论:
- 高剂量质子抑制剂 (PPI) 的使用独立地与肝硬化患者的死亡率增加有关.
- 这些发现表明,高剂量的PPI治疗与患重症肝硬化并发症的风险增加有关,包括复发性肝脑病,SBP和胃肠道出血.
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