Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand.
J Pediatr Gastroenterol Nutr. 2018 Sep;67(3):335-340. doi: 10.1097/MPG.0000000000001984.
The possible association between the use of proton pump inhibitors (PPIs) and community-acquired pneumonia (CAP) or another lower respiratory tract infection (LRTI) remains uncertain. We conducted a nested case-control study using routinely collected national health and drug dispensing data in New Zealand to examine the risk of CAP or another LRTI resulting in hospitalization or death in infants dispensed a PPI.
The cohort included 21,991 patients without a history of CAP or another LRTI who were born between 1 January 2005 and 31 December 2012 and were dispensed omeprazole, lansoprazole, or pantoprazole (the PPIs available in New Zealand during the study period) on at least one occasion during the first year of life. Cases had a first diagnosis after cohort entry (first PPI dispensing) of CAP (n = 65) validated by hospital discharge letter or death record, and chest radiography; or LRTI (including CAP) (n = 566) validated by hospital discharge letter or death record, with or without chest radiography. Up to 10 controls, matched by sex and date of birth, were randomly selected for each case. We conducted complete case analyses for the fully adjusted models.
In the adjusted analysis based on CAP cases and their controls, the matched odds ratio for current versus past use of PPIs was 0.88 (95% confidence interval 0.36-2.16). For all LRTI cases and their controls, the matched odds ratio was 1.13 (0.87-1.48).
In otherwise healthy community-dwelling infants, current use of a PPI does not appear to increase the risk of CAP or other LRTIs.
质子泵抑制剂（PPIs）的使用与社区获得性肺炎（CAP）或其他下呼吸道感染（LRTI）之间可能存在关联，但目前仍不确定。我们使用新西兰常规收集的国家卫生和药物配药数据开展了一项嵌套病例对照研究，以检查在婴儿中使用 PPI 与 CAP 或其他 LRTI 导致住院或死亡的风险。
该队列纳入了 21991 名无 CAP 或其他 LRTI 病史的患者，他们于 2005 年 1 月 1 日至 2012 年 12 月 31 日期间出生，且在生命的第一年至少有一次接受过奥美拉唑、兰索拉唑或泮托拉唑（研究期间新西兰可用的 PPIs）的处方。病例在队列入组（首次 PPI 配药）后出现了 CAP（n=65）的首次诊断，该诊断通过住院记录或死亡记录和胸部 X 线检查进行验证；或 LRTI（包括 CAP）（n=566）的首次诊断，该诊断通过住院记录或死亡记录进行验证，无论是否进行了胸部 X 线检查。对于每个病例，我们随机选择了最多 10 名性别和出生日期相匹配的对照者。我们对完全调整后的模型进行了全病例分析。
在基于 CAP 病例及其对照者的调整分析中，当前 PPI 使用与既往 PPI 使用的比值比为 0.88（95%置信区间 0.36-2.16）。对于所有 LRTI 病例及其对照者，比值比为 1.13（0.87-1.48）。
在其他方面健康的社区居住婴儿中，当前使用 PPI 似乎不会增加 CAP 或其他 LRTI 的风险。
