Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Science, Wayne State University, St John Hospital and Medical Center, Detroit, MI 48201, USA.
Expert Rev Clin Pharmacol. 2012 May;5(3):337-44. doi: 10.1586/ecp.12.20.
This study was presented at the American College of Chest Physicians meeting in Pittsburgh (PA, USA) in October 2011. The study objective was to evaluate the association of proton pump inhibitors (PPIs) and community-acquired pneumonia (CAP). The design was a meta-analysis of nine case-controlled and cohort studies. 120,863 pneumonia cases from 1987 to 2006 were included in the meta-analysis. PubMed and Ovid Medline were searched from inception through May 2011 by two investigators independently using keywords: PPI, pneumonia, CAP, anti-ulcer, antacid, omeprazole, esomeprazole, lansoprazole, pantoprazole and rabeprazole. This meta-analysis only included case-controlled and cohort studies that were published in full in English and evaluated PPI use and CAP incidence. Studies were excluded if they included the following patients: pediatric, Helicobacter pylori treatment and critically ill. Bibliographies of recent review articles and systematic reviews were hand-searched. Quality of studies was assessed using the Newcastle-Ottawa Quality Assessment Scale. Two investigators independently extracted data into standardized data collection forms that were confirmed by a third investigator. Data were analyzed based on current use of PPIs, duration of PPI use (<30 days or >180 days) and PPI dose (high vs low). Overall association of PPI and CAP was analyzed using the random effects model (Comprehensive Meta analysis(®) Version 2.0). Nine studies met all criteria for the primary outcome. Newcastle-Ottawa Quality Assessment Scale scores ranged from 4 to 8 out of 9. Current use of PPIs (odds ratio [OR]: 1.39; 95% CI: 1.09-1.76), PPI use <30 days (OR: 1.65; 95% CI: 1.25-2.19), PPI high dose (OR: 1.50; 95% CI: 1.33-1.68) and PPI low dose (OR: 1.17; 95% CI: 1.11-1.24) were significantly associated with CAP. There was no association between CAP and PPI use >180 days (OR: 1.10; 95% CI: 1.00-1.21). In conclusion, patients currently receiving PPIs, particularly <30 days or high dose, showed an association with CAP. Practitioners need to be vigilant about adverse effects of PPIs and consider alternative therapies.
这项研究在美国胸科医师学会会议（美国宾夕法尼亚州匹兹堡）上进行了展示，时间是 2011 年 10 月。该研究的目的是评估质子泵抑制剂（PPIs）与社区获得性肺炎（CAP）之间的关联。设计是对 9 项病例对照和队列研究进行的荟萃分析。这项荟萃分析纳入了 1987 年至 2006 年间的 120863 例肺炎病例。两位研究者使用关键词：PPI、肺炎、CAP、抗溃疡、抗酸剂、奥美拉唑、埃索美拉唑、兰索拉唑、泮托拉唑和雷贝拉唑，于 2011 年 5 月前分别在 PubMed 和 Ovid Medline 上进行了独立搜索。这项荟萃分析仅纳入了以英文全文发表的、评估 PPI 使用与 CAP 发生率的病例对照和队列研究。如果研究包括以下患者，则将其排除在外：儿科患者、幽门螺杆菌治疗患者和危重症患者。最近的综述文章和系统综述的参考文献也进行了手工检索。使用纽卡斯尔-渥太华质量评估量表评估研究质量。两位研究者将数据独立地提取到标准化数据采集表中，然后由第三位研究者进行确认。根据当前使用 PPI、PPI 使用时间（<30 天或>180 天）和 PPI 剂量（高 vs 低），对 PPI 和 CAP 的总体相关性进行分析。使用随机效应模型（Comprehensive Meta analysis(®) Version 2.0）分析 PPI 和 CAP 的总体相关性。有 9 项研究符合主要结局的所有标准。纽卡斯尔-渥太华质量评估量表评分为 9 分中的 4 分至 8 分。当前使用 PPI（比值比 [OR]：1.39；95%CI：1.09-1.76）、PPI 使用<30 天（OR：1.65；95%CI：1.25-2.19）、PPI 高剂量（OR：1.50；95%CI：1.33-1.68）和 PPI 低剂量（OR：1.17；95%CI：1.11-1.24）与 CAP 显著相关。而 CAP 与 PPI 使用>180 天无相关性（OR：1.10；95%CI：1.00-1.21）。总之，目前正在接受 PPI 治疗的患者，特别是在接受<30 天或高剂量 PPI 治疗的患者，与 CAP 相关。临床医生需要警惕 PPI 的不良反应，并考虑替代疗法。
