Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark.
Sanofi Aventis R&D, Paris, France.
Hepatology. 2016 Oct;64(4):1265-72. doi: 10.1002/hep.28737. Epub 2016 Aug 24.
Proton pump inhibitors (PPIs) may be a risk factor for hepatic encephalopathy (HE) in patients with cirrhosis, possibly through translocation of gut bacteria, which can also lead to spontaneous bacterial peritonitis (SBP). We examined the associations between PPIs and development of HE or SBP in patients with cirrhosis with ascites. We used data from three 1-year trials of satavaptan for ascites control. We used Cox regression to compare HE and SBP rates between users and nonusers of PPIs. At inclusion, 39% of the 865 patients with cirrhosis with ascites used PPIs, 52% used them at some point during the follow-up, and the proportion of current users was always in the 30%-39% range. There were 189 first-time HE episodes during the follow-up, and the cumulative 1-year risk was 31% for those who used PPIs at baseline versus 25% for those who did not. The confounder-adjusted hazard ratio (HR) of HE for current PPI use versus current nonuse was 1.36 (95% confidence interval [CI], 1.01-1.84). The HR for overt HE was higher (adjusted HR = 1.88; 95% CI, 1.21-1.91). During the follow-up, 86 patients developed SBP. The adjusted HR of SBP for current PPI users versus nonusers was 1.72 (95% CI, 1.10-2.69).
PPIs were used by 52% of this international cirrhosis cohort during a 1-year period and was a risk factor for developing HE and SBP. These findings are consistent with the hypothesis that PPIs may increase translocation of gut bacteria. (Hepatology 2016;64:1265-1272).
质子泵抑制剂 (PPIs) 可能是肝硬化患者肝性脑病 (HE) 的一个危险因素，可能通过肠道细菌易位引起，也可能导致自发性细菌性腹膜炎 (SBP)。我们研究了肝硬化伴腹水患者中 PPI 与 HE 或 SBP 发展之间的相关性。我们使用了三个为期 1 年的 Satavaptan 治疗腹水控制试验的数据。我们使用 Cox 回归比较了 PPI 使用者和非使用者的 HE 和 SBP 发生率。在纳入时，865 例肝硬化伴腹水患者中有 39%使用了 PPI，52%在随访期间的某个时间点使用了 PPI，当前使用者的比例始终在 30%-39%之间。在随访期间，发生了 189 例首次 HE 发作，使用 PPI 的患者在 1 年内的累积风险为 31%，而未使用 PPI 的患者为 25%。当前 PPI 使用与当前非使用相比，HE 的调整后的危害比 (HR) 为 1.36(95%置信区间 [CI]，1.01-1.84)。显性 HE 的 HR 更高(调整 HR = 1.88;95%CI，1.21-1.91)。在随访期间，86 例患者发生 SBP。当前 PPI 使用者与非使用者的 SBP 调整后 HR 为 1.72(95%CI，1.10-2.69)。
在 1 年期间，该国际肝硬化队列中有 52%的患者使用了 PPI，这是发生 HE 和 SBP 的危险因素。这些发现与 PPI 可能增加肠道细菌易位的假说一致。(Hepatology 2016;64:1265-1272)。
