Miozzo Suelen A S, John Jorge A, Appel-da-Silva Marcelo C, Dossin Isabella A, Tovo Cristiane V, Mattos Angelo A
Graduate Program in Medicine, Hepatology, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre CEP 90430-080, Brazil.
World J Hepatol. 2017 Dec 18;9(35):1278-1285. doi: 10.4254/wjh.v9.i35.1278.
To investigate whether the use of proton pump inhibitors (PPIs) increases the incidence of spontaneous bacterial peritonitis (SBP) in patients with cirrhosis and ascites.
An historical cohort study was carried out in cirrhotic outpatients with ascites followed in a specialized clinic at a tertiary hospital in Southern Brazil. Patient charts were reviewed to collect information on the variables of interest as the use of PPIs. Primary outcome was defined as development of SBP during the study period. SBP was diagnosed based on ascitic fluid polymorphonuclear cell count ≥ 250 cells/mm³ without evidence of an intra-abdominal, surgically treatable source of infection.
Of 738 cirrhotic patients, 582 (58.2% male) were enrolled, with mean age of 53.6 ± 12 years. Hepatitis C virus infection (36.2%) and alcohol abuse (25.6%) were the main etiologies of cirrhosis. The presence of ascites was detected in 299 (51.4%) patients during the development of the study. Nineteen patients with previous diagnosis of SBP undergoing secondary prophylaxis and 22 patients with insufficient PPI data were further excluded. Of 258 patients with ascites, 151 used PPIs, and 34 developed SBP (22.5%). Among 107 non-users of PPIs, 23 developed SBP (21.5%) (HR = 1.44, 95%CI: 0.85-2.47, = 0.176). The median follow-up time of patients using PPI was 27 mo 32 mo for non-users. Univariate analysis of the risk factors associated with the development of SBP revealed a significant association of SPB with the severity of liver disease according to the Child-Turcotte-Pugh (CTP) score. Multivariate analysis confirmed that CTP score was the only independent variable influencing the occurrence of SBP. Survival at 60 mo (Kaplan-Meier analysis) was similar in users and non-users of PPI, independently of the presence of SBP (58.4% 62.7% respectively, = 0.66). For patients with SBP, survival at 60 mo was 55.1%, 61.7% in patients without SBP ( = 0.34).
In conclusion, the rate of SBP was not significantly different in users or non-users of PPIs in this cohort of cirrhotic with ascites.
探讨使用质子泵抑制剂（PPI）是否会增加肝硬化腹水患者自发性细菌性腹膜炎（SBP）的发生率。
在巴西南部一家三级医院的专科门诊对肝硬化腹水门诊患者进行了一项历史性队列研究。查阅患者病历以收集如PPI使用情况等感兴趣变量的信息。主要结局定义为研究期间SBP的发生。SBP根据腹水多形核细胞计数≥250个细胞/mm³且无腹腔内可手术治疗的感染源证据来诊断。
738例肝硬化患者中，582例（58.2%为男性）被纳入研究，平均年龄为53.6±12岁。丙型肝炎病毒感染（36.2%）和酒精滥用（25.6%）是肝硬化的主要病因。在研究开展期间，299例（51.4%）患者被检测出存在腹水。19例先前诊断为SBP正在接受二级预防的患者以及22例PPI数据不足的患者被进一步排除。在258例有腹水的患者中，151例使用了PPI，34例发生了SBP（22.5%）。在107例未使用PPI的患者中，23例发生了SBP（21.5%）（风险比=1.44，95%置信区间：0.85 - 2.47，P = 0.176）。使用PPI的患者中位随访时间为27个月，未使用者为32个月。对与SBP发生相关的危险因素进行单因素分析发现，根据Child-Turcotte-Pugh（CTP）评分，SBP与肝病严重程度存在显著关联。多因素分析证实CTP评分是影响SBP发生的唯一独立变量。60个月时的生存率（Kaplan-Meier分析）在PPI使用者和未使用者中相似，与是否存在SBP无关（分别为58.4%和62.7%，P = 0.66）。对于发生SBP的患者，60个月时的生存率为55.1%，未发生SBP的患者为61.7%（P = 0.34）。
总之，在这个肝硬化腹水队列中，PPI使用者和未使用者发生SBP的比率无显著差异。
