Xu H B, Wang H D, Li C H, Ye S, Dong M S, Xia Q J, Zhang A Q, Pan K, Ge X L, Dong J H
Hospital and Institute of Hepatobiliary Surgery, PLA General Hospital, Beijing, China.
Department of Hepatobiliary Surgery, The Second Hospital of Dalian Medical University, Dalian, China.
Genet Mol Res. 2015 Jul 6;14(3):7490-501. doi: 10.4238/2015.July.3.25.
We used a meta-analysis approach to investigate the association between proton pump inhibitor (PPI) use and risk of spontaneous bacterial peritonitis (SBP) in cirrhotic patients. We searched Ovid Medline, Embase, and the Cochrane Library to identify eligible studies. We included studies that compared cirrhotic patients who did or did not use PPIs. The primary outcome was SBP, and the secondary outcome was overall bacterial infection. Results were pooled using random-effect models. This process led to identification of 12 journal articles and 5 conference abstracts. The pooled data showed that PPI use in patients with cirrhosis and ascites was significantly associated with an increased risk of SBP [odds ratio (OR) = 2.17; 95% confidence interval (CI) = 1.46-3.23; P < 0.05; I2 = 85.6%] and overall risk of bacterial infection (OR = 1.98; 95%CI = 1.36-2.87; P < 0.05; I2 = 0). Subgroup analysis revealed that journal articles and studies reporting adjusted effect estimates demonstrated that PPI users had a significantly increased risk of SBP (OR = 2.13; 95%CI = 1.61-2.82; P < 0.05; I2 = 29.4%; and OR = 1.98; 95%CI = 1.42-2.77; P < 0.05; I2 = 67%, respectively). In conclusion, PPI use increased the risk of SBP and overall bacterial infection in patients with cirrhosis and ascites. PPIs should be administered after careful assessment of the indications in cirrhotic patients. Future well-designed prospective studies are warranted to clarify the dose relationships and to compare infection risks associated with different classes of PPIs.
我们采用荟萃分析方法，研究肝硬化患者使用质子泵抑制剂（PPI）与自发性细菌性腹膜炎（SBP）风险之间的关联。我们检索了Ovid Medline、Embase和Cochrane图书馆，以确定符合条件的研究。我们纳入了比较使用或未使用PPI的肝硬化患者的研究。主要结局是SBP，次要结局是总体细菌感染。使用随机效应模型汇总结果。这一过程共识别出12篇期刊文章和5篇会议摘要。汇总数据显示，肝硬化腹水患者使用PPI与SBP风险增加显著相关[比值比（OR）=2.17；95%置信区间（CI）=1.46 - 3.23；P<0.05；I2 = 85.6%]，以及总体细菌感染风险（OR = 1.98；95%CI = 1.36 - 2.87；P<0.05；I2 = 0）。亚组分析显示，报告调整效应估计值的期刊文章和研究表明，PPI使用者发生SBP的风险显著增加（OR = 2.13；95%CI = 1.61 - 2.82；P<0.05；I2 = 29.4%；以及OR = 1.98；95%CI = 1.42 - 2.77；P<0.05；I2 = 67%）。总之，使用PPI会增加肝硬化腹水患者发生SBP和总体细菌感染的风险。在对肝硬化患者的适应症进行仔细评估后，方可使用PPI。未来有必要开展设计良好的前瞻性研究，以阐明剂量关系，并比较不同类别PPI相关的感染风险。
