Sarkar Monika, Hennessy Sean, Yang Yu-Xiao
University of Pennsylvania, Philadelphia, Pennsylvania 19104-6021, USA.
Ann Intern Med. 2008 Sep 16;149(6):391-8. doi: 10.7326/0003-4819-149-6-200809160-00005.
Recent studies suggest that proton-pump inhibitors (PPIs) may increase the risk for community-acquired pneumonia (CAP).
To examine the association between PPI use and CAP in adults followed in general practices in the United Kingdom.
Nested case-control study.
The General Practice Research Database (1987 to 2002) in the United Kingdom.
Patients age 18 years or older with at least 6 months of initial pneumonia-free follow-up in the database. Case patients (n = 80 066) were defined as those who received an incident diagnosis of CAP. Control participants (n = 799 881) were selected by using incidence density sampling, matching on practice site, calendar period, and follow-up duration.
Use of PPIs within 30 days before the index date. Adjusted odds ratios (ORs) were estimated by using conditional logistic regression, adjusting for potential confounders.
Overall, current PPI use was not associated with an increased risk for CAP (adjusted OR, 1.02 [95% CI, 0.97 to 1.08]) or risk for CAP that required hospitalization (adjusted OR, 1.01 [CI, 0.91 to 1.12]). There was a strong increase in risk for CAP associated with current use of PPI therapy that was started within the previous 2 days (adjusted OR, 6.53 [CI, 3.95 to 10.80]), 7 days (adjusted OR, 3.79 [CI, 2.66 to 5.42]), and 14 days (adjusted OR, 3.21 [CI, 2.46 to 4.18]), but there was no statistically significant association for longer-term current PPI therapy. A separate matched case-control analysis, which included the 3 strongest confounders as additional matching factors, yielded similar results as the primary analysis (adjusted OR, 0.96 [CI, 0.91 to 1.02]).
Adherence to PPI prescription was assumed to be 100%. No radiographic evidence was available to corroborate a diagnosis of CAP.
Proton-pump inhibitor therapy started within the past 30 days was associated with an increased risk for CAP, whereas longer-term current use was not.
近期研究表明，质子泵抑制剂（PPIs）可能会增加社区获得性肺炎（CAP）的风险。
在英国的普通医疗实践中，研究成人使用PPIs与CAP之间的关联。
巢式病例对照研究。
英国的全科医学研究数据库（1987年至2002年）。
数据库中年龄在18岁及以上、初始无肺炎随访至少6个月的患者。病例患者（n = 80066）定义为那些被确诊为CAP的患者。对照参与者（n = 799881）通过发病密度抽样选择，根据医疗机构地点、日历时间段和随访时长进行匹配。
索引日期前30天内PPIs的使用情况。使用条件逻辑回归估计调整后的比值比（OR），并对潜在混杂因素进行调整。
总体而言，当前使用PPIs与CAP风险增加无关（调整后的OR为1.02 [95% CI，0.97至1.08]），也与需要住院治疗的CAP风险无关（调整后的OR为1.01 [CI，0.91至1.12]）。在过去2天内开始使用的PPIs治疗与CAP风险大幅增加相关（调整后的OR为6.53 [CI，3.95至10.80]），7天内开始使用的相关风险为（调整后的OR为3.79 [CI，2.66至5.42]），14天内开始使用的相关风险为（调整后的OR为3.21 [CI，2.46至4.18]），但长期当前使用PPIs治疗则无统计学上的显著关联。一项单独的匹配病例对照分析，将3个最强的混杂因素作为额外的匹配因素，得出了与主要分析相似的结果（调整后的OR为0.96 [CI，0.91至1.02]）。
假设对PPI处方的依从性为100%。没有影像学证据来证实CAP的诊断。
过去30天内开始的质子泵抑制剂治疗与CAP风险增加相关，而长期当前使用则不然。
