Momosaki Ryo, Yasunaga Hideo, Matsui Hiroki, Fushimi Kiyohide, Abo Masahiro
Department of Rehabilitation Medicine, The Jikei University School of Medicine, Tokyo, Japan.
Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan.
J Stroke Cerebrovasc Dis. 2016 May;25(5):1035-1040. doi: 10.1016/j.jstrokecerebrovasdis.2016.01.018. Epub 2016 Feb 4.
Pneumonia is a serious complication of stroke. Several studies have indicated that certain gastric acid suppressants may be associated with an increased risk of pneumonia in hospitalized patients. However, the association between type of acid suppressant and pneumonia in acute stroke patients remains controversial. The purpose of this study was to clarify the association between the type of acid suppressant and the occurrence of pneumonia in acute stroke patients.
This retrospective observational study used data from the national Japanese Diagnosis Procedure Combination inpatient database. We identified patients who were admitted to acute-care hospitals with stroke. The outcome was the occurrence of pneumonia assessed using diagnostic codes. We performed propensity score-matched analysis to compare the outcome between proton pump inhibitor (PPI) users and histamine-2 receptor antagonist (H2RA) users.
A total of 77,890 stroke patients were identified, of whom 63,980 were prescribed H2RAs and 13,910 were prescribed PPIs. Overall, 1490 (10.7%) of the patients receiving PPIs and 6401 (10.0%) of the patients receiving H2RAs developed pneumonia after stroke. After propensity score matching, the incidence of pneumonia in PPI users was not different from that in H2RA users (odds ratio: 1.10, 95% confidence interval: .99-1.21).
No significant difference in the incidence of pneumonia was seen between users of PPIs and H2RAs after acute stroke.
肺炎是中风的一种严重并发症。多项研究表明，某些胃酸抑制剂可能与住院患者肺炎风险增加有关。然而，急性中风患者中胃酸抑制剂类型与肺炎之间的关联仍存在争议。本研究的目的是阐明急性中风患者中胃酸抑制剂类型与肺炎发生之间的关联。
这项回顾性观察性研究使用了日本全国诊断程序组合住院患者数据库中的数据。我们确定了入住急症医院的中风患者。结局是使用诊断编码评估的肺炎发生情况。我们进行了倾向评分匹配分析，以比较质子泵抑制剂（PPI）使用者和组胺-2受体拮抗剂（H2RA）使用者之间的结局。
共确定了77890例中风患者，其中63980例开具了H2RA处方，13910例开具了PPI处方。总体而言，接受PPI治疗的患者中有1490例（10.7%），接受H2RA治疗的患者中有6401例（10.0%）在中风后发生了肺炎。倾向评分匹配后，PPI使用者的肺炎发生率与H2RA使用者无差异（优势比：1.10,95%置信区间：.99-1.21）。
急性中风后，PPI使用者和H2RA使用者的肺炎发生率无显著差异。
