Khan Muhammad Ali, Kamal Sehrish, Khan Sobia, Lee Wade M, Howden Colin W
aDivision of Gastroenterology, University of Tennessee Health Science Center, Memphis, Tennessee bDepartment of Internal Medicine cMulford and Carlson Libraries, University of Toledo, Toledo, Ohio, USA.
Eur J Gastroenterol Hepatol. 2015 Nov;27(11):1327-36. doi: 10.1097/MEG.0000000000000448.
Observational studies have presented conflicting results with regard to an association between gastric acid suppression and spontaneous bacterial peritonitis (SBP). Our aim was to carry out a meta-analysis investigating the possible association between the use of proton pump inhibitors or H2-receptor antagonists and SBP.
We searched several databases from inception through 15 December 2014 to identify observational studies that provided data on the association of gastric acid suppression with SBP as their primary outcome, and carried out random effects meta-analyses.
Fourteen observational studies (six case-control and eight cohort) evaluating the association between proton pump inhibitors and SBP revealed a pooled odds ratio (OR) of 2.32 [95% confidence interval (CI) 1.57-3.42, I(2)=82%]. The subgroup analysis based on study design revealed a pooled OR of 2.52 (95% CI 1.71-3.71, I(2)=16%) for case-control studies, and a pooled OR of 2.18 (95% CI 1.24-3.82, I(2)=89%) for cohort studies. Sensitivity analysis including only the peer-reviewed publications in the cohort subgroup revealed a pooled OR of 1.49 (95% CI 1.15-1.95, I(2)=27%). The subgroup analysis for high-quality studies revealed a pooled OR of 1.49 (95% CI 1.19-1.88, I(2)=21%). The pooled OR for H2-receptor antagonists and SBP was 1.93 (95% CI 1.15-3.24, I(2)=0%).
There appear to be statistically significant, but quantitatively small, associations between gastric acid suppression and SBP. However, the magnitude of the possible association diminished when analysis focused on higher quality data that were more robust. Furthermore, the quality evidence in support of the association, as per the GRADE framework, was very low.
关于胃酸抑制与自发性细菌性腹膜炎（SBP）之间的关联，观察性研究给出了相互矛盾的结果。我们的目的是进行一项荟萃分析，以研究使用质子泵抑制剂或H2受体拮抗剂与SBP之间可能存在的关联。
我们检索了从数据库建立至2014年12月15日的多个数据库，以识别那些提供了胃酸抑制与SBP关联数据作为其主要结果的观察性研究，并进行随机效应荟萃分析。
14项评估质子泵抑制剂与SBP关联的观察性研究（6项病例对照研究和8项队列研究）显示，合并比值比（OR）为2.32 [95%置信区间（CI）1.57 - 3.42，I² = 82%]。基于研究设计的亚组分析显示，病例对照研究的合并OR为2.52（95% CI 1.71 - 3.71，I² = 16%），队列研究的合并OR为2.18（95% CI 1.24 - 3.82，I² = 89%）。仅纳入队列亚组中经同行评审的出版物的敏感性分析显示，合并OR为1.49（95% CI 1.15 - 1.95，I² = 27%）。高质量研究的亚组分析显示，合并OR为1.49（95% CI 1.19 - 1.88，I² = 21%）。H2受体拮抗剂与SBP的合并OR为1.93（95% CI 1.15 - 3.24，I² = 0%）。
胃酸抑制与SBP之间似乎存在统计学上显著但数量上较小的关联。然而，当分析集中于更可靠的高质量数据时，可能关联的程度有所降低。此外，根据GRADE框架，支持该关联的质量证据非常低。
