Kaiser Permanente Division of Research, Oakland, California.
Kaiser Permanente Division of Research, Oakland, California.
Gastroenterology. 2017 Mar;152(4):821-829.e1. doi: 10.1053/j.gastro.2016.11.023. Epub 2016 Nov 24.
BACKGROUND & AIMS: Proton pump inhibitors (PPIs) and histamine-2 receptor antagonists (H2RAs) suppress gastric acid production, which can inhibit iron absorption. However, few data exist regarding whether these medications increase the risk of clinical iron deficiency.
A community-based case-control study evaluated the association between acid-suppressing medication use and the subsequent risk of iron deficiency. It contrasted 77,046 patients with new iron deficiency diagnoses (January 1999-December 2013), with 389,314 controls. Medication exposures, outcomes, and potential confounders used electronic databases. We excluded patients with pre-existing risk factors for iron deficiency. Associations were estimated using conditional logistic regression.
Among cases, 2343 (3.0%) received a prior ≥2-year supply of PPIs and 1063 (1.4%) received H2RAs (without PPI use). Among controls, 3354 (0.9%) received a prior ≥2-year supply of PPIs and 2247 (0.6%) H2RAs. Both ≥2 years of PPIs (adjusted odds ratio, 2.49; 95% confidence interval, 2.35-2.64) and ≥2 years of H2RAs (odds ratio, 1.58; 95% CI, 1.46-1.71) were associated with an increased subsequent risk for iron deficiency. Among PPI users, the associations were stronger for higher daily doses (>1.5 vs <0.75 PPI pills/d; P value interaction = .004) and decreased after medication discontinuation (P-trend < .001). Some of the strongest associations were among persons taking >1.5 pills per day for at least 10 years (odds ratio, 4.27; 95% CI, 2.53-7.21). No similar strong associations were found for other commonly used prescription medications.
Among patients without known risk factors for iron deficiency, gastric acid inhibitor use for ≥2 years was associated with an increased subsequent risk of iron deficiency. The risk increased with increasing potency of acid inhibition and decreased after medication discontinuation.
质子泵抑制剂（PPIs）和组胺 2 受体拮抗剂（H2RAs）抑制胃酸生成，这可能会抑制铁吸收。然而，关于这些药物是否会增加临床缺铁的风险，数据很少。
一项基于社区的病例对照研究评估了抑酸药物使用与随后缺铁风险之间的关联。它比较了 77046 例新诊断为缺铁的患者（1999 年 1 月至 2013 年 12 月）和 389314 例对照。药物暴露、结局和潜在混杂因素使用电子数据库。我们排除了有缺铁危险因素的患者。使用条件逻辑回归估计关联。
在病例中，2343 例（3.0%）接受了≥2 年的 PPI 治疗，1063 例（1.4%）接受了 H2RA 治疗（未使用 PPI）。在对照组中，3354 例（0.9%）接受了≥2 年的 PPI 治疗，2247 例（0.6%）接受了 H2RA 治疗。≥2 年的 PPI（调整后的优势比，2.49；95%置信区间，2.35-2.64）和≥2 年的 H2RA（优势比，1.58；95%置信区间，1.46-1.71）与随后发生缺铁的风险增加相关。在 PPI 使用者中，较高的日剂量（>1.5 与<0.75 PPI 片/天；P 值交互作用=0.004）和停药后（P 趋势<0.001）的相关性更强。在至少服用 10 年每天 1.5 片以上的人群中，相关性最强（优势比，4.27；95%置信区间，2.53-7.21）。对于其他常用处方药，未发现类似的强相关性。
在没有已知缺铁危险因素的患者中，使用胃酸抑制剂≥2 年与随后缺铁的风险增加相关。随着胃酸抑制作用的增强，风险增加，停药后风险降低。
