Song Young Rim, Kim Hyung Jik, Kim Jwa-Kyung, Kim Sung Gyun, Kim Sung Eun
Young Rim Song, Hyung Jik Kim, Jwa-Kyung Kim, Sung Gyun Kim, Division of Nephrology, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Kidney Research Institute, Hallym University College of Medicine, Anyang-si 431-070, South Korea.
World J Gastroenterol. 2015 Apr 28;21(16):4919-24. doi: 10.3748/wjg.v21.i16.4919.
To investigate the preventive effects of low-dose proton-pump inhibitors (PPIs) for upper gastrointestinal bleeding (UGIB) in end-stage renal disease.
This was a retrospective cohort study that reviewed 544 patients with end-stage renal disease who started dialysis at our center between 2005 and 2013. We examined the incidence of UGIB in 175 patients treated with low-dose PPIs and 369 patients not treated with PPIs (control group).
During the study period, 41 patients developed UGIB, a rate of 14.4/1000 person-years. The mean time between the start of dialysis and UGIB events was 26.3 ± 29.6 mo. Bleeding occurred in only two patients in the PPI group (2.5/1000 person-years) and in 39 patients in the control group (19.2/1000 person-years). Kaplan-Meier analysis of cumulative non-bleeding survival showed that the probability of UGIB was significantly lower in the PPI group than in the control group (log-rank test, P < 0.001). Univariate analysis showed that coronary artery disease, PPI use, anti-coagulation, and anti-platelet therapy were associated with UGIB. After adjustments for the potential factors influencing risk of UGIB, PPI use was shown to be significantly beneficial in reducing UGIB compared to the control group (HR = 13.7, 95%CI: 1.8-101.6; P = 0.011).
The use of low-dose PPIs in patients with end-stage renal disease is associated with a low frequency of UGIB.
探讨小剂量质子泵抑制剂（PPIs）对终末期肾病患者上消化道出血（UGIB）的预防作用。
这是一项回顾性队列研究，纳入了2005年至2013年间在本中心开始透析的544例终末期肾病患者。我们调查了175例接受小剂量PPIs治疗的患者和369例未接受PPIs治疗的患者（对照组）的UGIB发生率。
在研究期间，41例患者发生UGIB，发生率为14.4/1000人年。透析开始至UGIB事件的平均时间为26.3±29.6个月。PPIs组仅有2例患者发生出血（2.5/1000人年），对照组有39例患者发生出血（19.2/1000人年）。累积无出血生存的Kaplan-Meier分析显示，PPIs组UGIB的发生率显著低于对照组（对数秩检验，P<0.001）。单因素分析显示，冠状动脉疾病、使用PPIs、抗凝和抗血小板治疗与UGIB有关。在对影响UGIB风险的潜在因素进行调整后，与对照组相比，使用PPIs在降低UGIB方面具有显著益处（HR=13.7，95%CI：1.8-101.6；P=0.011）。
终末期肾病患者使用小剂量PPIs与UGIB的低发生率相关。
