Kim Jung Hee, Lim Kyung Sook, Min Yang Won, Lee Hyuk, Min Byung-Hoon, Rhee Poong-Lyul, Kim Jae J, Koh Kwang Cheol, Paik Seung Woon
Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
J Gastroenterol Hepatol. 2017 May;32(5):1064-1070. doi: 10.1111/jgh.13637.
The present study aimed to assess the real impact of proton pump inhibitor (PPI) use on incidence of recurrent spontaneous bacterial peritonitis (SBP) in a homogenous population composed of cirrhotic patients with a previous SBP where differences related with SBP incidence between PPI users and non-users are less likely to exist.
This retrospective cohort study enrolled 307 cirrhotic patients taking diuretics for ascites control and had a previous SBP. Patients who took any PPI for at least 1 week prior to a second SBP were included in the PPI group. The incidence of a second SBP was a primary outcome and was compared between PPI group and non-PPI group before and after propensity score matching. Risk factors for a second SBP were investigated by multivariate analysis.
Second SBP occurred in 17 patients (29.3%) during mean 52.1 ± 5.2 months of PPI group and in 60 patients (24.1%) during mean 61.9 ± 4.8 months of non-PPI group, which did not differ (P = .185). In the matched cohort, second SBP similarly occurred in both groups [29.3% of PPI group vs 26.8% of non-PPI group (P = .271)]. According to the multivariate analysis, Child-Pugh score was the only significant risk factor for a second SBP (hazard ratio 1.68, 95% confidence interval, 1.13-2.50, P = .001). Isolated bacteria and clinical outcomes such as of mortality, presence of sepsis, and hospital stay did not differ between the two groups in the matched cohort.
Proton pump inhibitor use is not a risk factor for recurrent SBP in cirrhotic patients.
本研究旨在评估质子泵抑制剂（PPI）的使用对既往有自发性细菌性腹膜炎（SBP）的肝硬化患者这一同质化人群中复发性SBP发生率的实际影响，在该人群中PPI使用者与非使用者之间与SBP发生率相关的差异不太可能存在。
这项回顾性队列研究纳入了307例因腹水控制而服用利尿剂且既往有SBP的肝硬化患者。在第二次SBP前至少服用1周任何PPI的患者被纳入PPI组。第二次SBP的发生率是主要结局，并在倾向评分匹配前后的PPI组和非PPI组之间进行比较。通过多变量分析研究第二次SBP的危险因素。
PPI组平均52.1±5.2个月期间有17例患者（29.3%）发生第二次SBP，非PPI组平均61.9±4.8个月期间有60例患者（24.1%）发生第二次SBP，两者无差异（P = 0.185）。在匹配队列中，两组第二次SBP的发生率相似[PPI组为29.3%，非PPI组为26.8%（P = 0.271）]。根据多变量分析，Child-Pugh评分是第二次SBP的唯一显著危险因素（风险比1.68，95%置信区间，1.13 - 2.50，P = 0.001）。在匹配队列中，两组之间的分离细菌以及死亡率、脓毒症的存在和住院时间等临床结局没有差异。
使用质子泵抑制剂不是肝硬化患者复发性SBP的危险因素。
