系统性硬化症中的质子抑制剂:我们应该谨慎吗? 来自大规模数据分析的见解
Irakli Tskhakaia1, Diego Lema2, Nanuka Tsibadze2
1Department of Medicine, Jefferson Einstein Hospital, 5501 Old York Road, Philadelphia, PA, 19141, USA. itskhakaia@uabmc.edu.
Clinical rheumatology
|September 11, 2025
概括
服用质子抑制剂 (PPI) 的全身性硬化症患者面临更高的慢性病和骨质疏松症风险. 然而,PPI对于管理SSc患者的GERD和肺部问题至关重要,需要有针对性的监测.
科学领域:
- 免疫学 免疫学 免疫学
- 腎臟病學 (nephrology) 是一種醫學.
- 胃肠病学 胃肠病学
- 药理学 药理学是指药理学的学科.
背景情况:
- 系统性硬化症 (SSc) 经常与胃食道逆流性疾病 (GERD) 一起发生,需要使用质子抑制剂 (PPI).
- 长期的PPI安全问题包括慢性病 (CKD),骨质疏松症和阿尔茨海默病.
- 这项研究调查了PPI的不良影响是否在SSc患者中被放大.
研究的目的:
- 与GERD患者相比,评估SSc患者的PPI扩大风险.
- 评估PPI使用与SSc中CKD,骨质疏松症和神经退行性疾病之间的关联.
- 在一个大型的SSc队列中提供PPI安全性的真实证据.
主要方法:
- 使用TrinetX研究网络 (>130万患者) 的回顾性观察分析.
- 研究人群:6800名SSc患者接受PPI治疗,1,889,433名GERD患者接受PPI治疗.
- 倾向性得分匹配和对CKD,骨质疏松症和痴呆症风险的评估.
主要成果:
- 接受PPI的SSc患者在匹配后显示CKD (AR 2.8%) 和骨质疏松症 (AR 9%) 的风险显著增加.
- 在SSc和GERD队列之间观察到晚期CKD阶段 (4,5) 的最小差异.
- 接受PPI的SSc患者患阿尔茨海默病的风险较低 (AR -0.7%).
结论:
- 尽管可能增加CKD和骨质疏松症的风险,但PPI治疗对于SSc管理至关重要.
- 在缓解GERD和肺部并发症方面,PPI的好处超过了SSc中放大风险.
- 建议在长期接受PPI治疗的SSc患者中对CKD和骨质疏松症进行有针对性的监测.
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