Bian Jin, Wang Anqiang, Lin Jianzhen, Wu Liangcai, Huang Hanchun, Wang Shanshan, Yang Xiaobo, Lu Xin, Xu Yiyao, Zhao Haitao
Department of Liver Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College (CAMS & PUMC), Beijing, China.
Medicine (Baltimore). 2017 Apr;96(17):e6723. doi: 10.1097/MD.0000000000006723.
BACKGROUND & AIMS: Several studies have shown that proton pump inhibitors (PPIs) use can increase the risk of developing hepatic encephalopathy (HE) in patients with liver dysfunction. However, no definite conclusion is drawn because of study design limitations. Therefore, we conducted a meta-analysis to explore the association between PPIs and HE.
We searched PubMed, EMBASE, and the Cochrane Library from inception until November 2016. Data from the identified studies were combined using a random effects model, and odds ratios (ORs) were calculated.
Three case-control studies were included. Compared with nonusers, hepatic insufficiency patients receiving PPIs therapy had a significantly increased risk of developing HE (OR = 1.76, 95% CI: 1.15-2.69), with notable heterogeneity (I = 61.4%, P = .075) and publication bias. No relevance was found between PPIs and HE after using the trim and fill method (OR = 1.360, 95%CI: 0.909-2.035, P = .135).
PPIs are associated with a higher risk of HE among patients with chronic and acute liver dysfunction. A final conclusion cannot be drawn because of the limited number of studies and a lack of prospective studies.
多项研究表明，使用质子泵抑制剂（PPI）会增加肝功能不全患者发生肝性脑病（HE）的风险。然而，由于研究设计的局限性，尚未得出明确结论。因此，我们进行了一项荟萃分析，以探讨PPI与HE之间的关联。
我们检索了从创刊至2016年11月的PubMed、EMBASE和Cochrane图书馆。使用随机效应模型合并已识别研究的数据，并计算比值比（OR）。
纳入三项病例对照研究。与未使用者相比，接受PPI治疗的肝功能不全患者发生HE的风险显著增加（OR = 1.76，95%CI：1.15 - 2.69），存在显著异质性（I = 61.4%，P = 0.075）和发表偏倚。使用剪补法后未发现PPI与HE之间存在相关性（OR = 1.360，95%CI：0.909 - 2.035，P = 0.135）。
PPI与慢性和急性肝功能不全患者发生HE的较高风险相关。由于研究数量有限且缺乏前瞻性研究，无法得出最终结论。
