质子抑制剂和上部胃肠道癌症:一项匹配的病例对照研究,根据指示解决混问题
medRxiv : the preprint server for health sciences
|June 26, 2025
概括
质子抑制剂 (PPI) 的使用与上部胃肠道癌症无关. 最初的关联是由于根据指示混,用PPI处方治疗可能表明癌症的早期症状.
科学领域:
- 胃肠病学 胃肠病学
- 在瘤学瘤学.
- 药理学 药理学是指药理学的学科.
背景情况:
- 质子抑制剂 (PPI) 广泛用于与酸有关的胃肠道疾病.
- 人们担心PPI使用与上部胃肠道 (GI) 癌症之间存在潜在的关联.
- 根据指示混,在PPI被处方用于可能先于癌症的症状时,是评估这种风险的一个重大挑战.
研究的目的:
- 调查质子抑制剂 (PPI) 使用与上部胃肠道 (GI) 癌症的风险之间的关联.
- 为了解决和减轻PPI-癌症协会中的潜在混.
- 要区分真正的与药物相关的风险和与所处所处的潜在疾病相关的风险,这些PPI被处方.
主要方法:
- 一项匹配的病例控制研究使用来自国家卫生服务提供商的电子健康记录进行.
- 875名被诊断为上部肠道癌症的患者与8750名无癌症的对照人群根据年龄,性别和族群进行了匹配.
- 使用多变量条件后勤回归来计算与PPI暴露相关的上部肠道癌症的调整几率比率 (aOR),考虑不同的时间窗口并根据肠道诊断进行调整.
主要成果:
- 初步分析显示,PPI在5年内使用与上部消化道恶性瘤几率增加之间存在关联 (例如,埃索梅普拉aOR3.90).
- 当通过时间窗口进行分析时,在诊断后六个月内使用PPI时,这种关联最强,在远程使用时则逆转 (例如,奥梅普拉>3年前:aOR 0.62).
- 在排除了使用的最后一年并根据与症状相关的诊断进行调整后,PPI使用和上部肠道癌症之间没有积极的关联.
结论:
- 观察到的PPI使用和上部消化道恶性瘤之间的关联似乎是由指标的混驱动的.
- PPI通常用于早期,与症状相关的疾病,这些疾病可能是癌症的前体.
- 考虑到PPI使用的时间和潜在的胃肠道诊断,没有发现与上胃肠道癌症的有害关联,这表明新的胃肠道症状需要对恶性瘤进行调查.
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