质子抑制剂使用与上部胃肠道癌症之间的关联:一项匹配的病例对照研究,根据指示计算反向因果关系和混
Ibrahim O Sawaid1, Zohar Din2, Efrat Golan3
1Drug Discovery Lab, Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel.
PLoS medicine
|January 6, 2026
概括
长期使用质子抑制剂 (PPI) 似乎不会增加上部胃肠道癌症的风险. 明显的关联与诊断前的时期有关,而不是药物本身.
科学领域:
- 胃肠病学 胃肠病学
- 在瘤学瘤学.
- 药学流行病学 药学流行病学
背景情况:
- 质子抑制剂 (PPI) 经常用于与酸有关的胃肠道疾病.
- 观察性研究表明,长期使用PPI与上部肠道癌症风险增加之间存在潜在联系.
- 在这些观察到的关联中,存在有关指示和反向因果关系的疑虑.
研究的目的:
- 调查PPI使用与上部肠道癌症之间的关联.
- 为了解决潜在的偏见,如通过指示和反向因果关系的混.
- 为了澄清PPI治疗持续时间和上部消化道恶性瘤风险之间的关系.
主要方法:
- 使用以色列电子健康记录进行了一项匹配的病例控制研究.
- 875例上部胃肠道癌症病例与8750例无癌症对照进行了匹配.
- 在各种诊断前的时间窗口中分析了PPI暴露,并对许多共同变量进行了调整.
主要成果:
- 初步分析显示,在使用PPI时,上部肠道癌症的几率增加,特别是在诊断前几个月.
- 在调整了与症状相关的诊断并排除了诊断前的最后一年后,这种关联消失了.
- 远程PPI使用 (超过3年前) 与某些PPI的癌症几率降低有关.
结论:
- PPI和上部肠道癌症之间的明显有害关联可能是由于混因素,而不是药物本身.
- 在经过适当调整后,在长期使用PPI时,没有发现上部肠道癌症的风险增加.
- 调查新出现的胃肠道症状至关重要,而不是仅仅将恶性瘤风险归因于抑制酸性治疗.
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