Lin Hsiu-Chen, Hsiao Yu-Ting, Lin Hsiu-Li, Uang Yow-Shieng, Cheng Hui-Wen, Wang Ying, Wang Li-Hsuan
Department of Pediatrics, School of Medicine, College of Medicine, Taipei Medical University, Taipei Department of Laboratory Medicine, Taipei Medical University Hospital, Taipei School of Public Health, College of Public Health and Nutrition, Taipei Medical University, Taipei School of Pharmacy, College of Pharmacy, Taipei Medical University, Taipei Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taipei Department of Neurology, Cathy General Hospital, Sijhih Branch, New Taipei City Department of Pharmacy, Taipei Medical University Hospital, Taipei, Taiwan.
Medicine (Baltimore). 2016 Jul;95(28):e4195. doi: 10.1097/MD.0000000000004195.
The aim of this study was to investigate the effects of proton pump inhibitors (PPIs) on the risk of diabetes mellitus (DM) among patients with upper gastrointestinal disease (UGID).
This was a retrospective cohort study with a follow-up period of 5 years. We identified 388,098 patients who were diagnosed with UGID between 2000 and 2006 from the Longitudinal Health Insurance Database of the Taiwan National Health Insurance program. We used Cox proportional hazard ratio (HR) to compare the risk of DM between UGID patients received PPIs and those did not receive PPIs. HRs were adjusted for possible confounders, including age, sex, hypertension, gout and/or hyperuricemia, coronary artery disease, stroke, pancreatitis, hyperlipidemia, obesity, H2-blocker use, and clozapine or olanzapine use. The dose-related effects of PPIs on the risk of DM were evaluated according to the defined daily dose (DDD).
The adjusted HR was 0.80 (95% CI, 0.73-0.88) for the study group (UGID patients with PPIs) compared with comparison group I (UGID patients without PPIs). Among patients who used PPIs, those older than 60 years of age had a lower risk of DM (HR, 0.73; 95% CI, 0.63-0.83) than those younger than 40 years. Additionally, the effect of PPIs was significantly dose-dependent (P for trend <0.001). Patients with UGID who received >540 DDDs of PPIs exhibited the greatest reduction in the risk of DM.
Our results demonstrated a decreased risk of DM in UGID patients who used PPIs; the risk appeared to be significantly dose-dependent.
本研究旨在调查质子泵抑制剂（PPIs）对上消化道疾病（UGID）患者患糖尿病（DM）风险的影响。
这是一项随访期为5年的回顾性队列研究。我们从台湾国民健康保险计划的纵向健康保险数据库中识别出2000年至2006年间被诊断为UGID的388,098名患者。我们使用Cox比例风险比（HR）来比较接受PPIs的UGID患者和未接受PPIs的患者患DM的风险。对HR进行了可能的混杂因素调整，包括年龄、性别、高血压、痛风和/或高尿酸血症、冠状动脉疾病、中风、胰腺炎、高脂血症、肥胖、使用H2阻滞剂以及使用氯氮平或奥氮平。根据规定日剂量（DDD）评估PPIs对DM风险的剂量相关影响。
与对照组I（未使用PPIs的UGID患者）相比，研究组（使用PPIs的UGID患者）的调整后HR为0.80（95%CI，0.73 - 0.88）。在使用PPIs的患者中，年龄大于60岁的患者患DM的风险（HR，0.73；95%CI，0.63 - 0.83）低于年龄小于40岁的患者。此外，PPIs的作用具有显著的剂量依赖性（趋势P<0.001）。接受PPIs超过540 DDDs的UGID患者患DM的风险降低最大。
我们的结果表明，使用PPIs的UGID患者患DM的风险降低；风险似乎具有显著的剂量依赖性。
