McCrory Bradley E, Harper Heidi N, McPhail Gary L
Division of Pharmacy, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
Division of Home Care Pharmacy, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
Pharmacotherapy. 2018 Jul;38(7):725-729. doi: 10.1002/phar.2125. Epub 2018 Jul 1.
To evaluate the incidence of adverse effects associated with chronic proton pump inhibitor (PPI) use as well as the dosing, indication, and duration of use of PPIs in the cystic fibrosis (CF) population at a pediatric academic medical center.
Study design was a retrospective chart review evaluating patients with CF who were prescribed a PPI for at least 6 months (PPI group) or patients with CF who had never been prescribed a PPI (control group) from June 1, 2014, to May 31, 2015.
The study enrolled 126 patients in the PPI group and 49 patients in the control group. Forty-four patients (34.9%) had an indication for both gastroesophageal reflux and enzyme enhancement, with an average PPI daily dose of 1 mg/kg/day. Twenty-one patients (16.7%) in the PPI group had an incidence of hypomagnesemia compared with one patient (2%) in the control group (p=0.097). Overall, 75 patients (59.6%) receiving chronic PPI therapy had at least one pulmonary exacerbation compared with 12 patients (24.5%) in the control group (p<0.001). No significant difference was noted in the incidence of hypocalcemia, low bone mineral density, or positive Clostridium difficile toxin between the two groups.
The PPI group had a higher risk of pulmonary exacerbation compared with the control group. Further studies are needed to assess adverse effects associated with chronic PPI use in patients with CF.
评估在一家儿科学术医疗中心囊性纤维化（CF）患者群体中，与长期使用质子泵抑制剂（PPI）相关的不良反应发生率，以及PPI的给药剂量、适应证和使用时长。
采用回顾性病历审查研究设计，评估2014年6月1日至2015年5月31日期间，接受PPI治疗至少6个月的CF患者（PPI组），或从未接受过PPI治疗的CF患者（对照组）。
该研究纳入了126例PPI组患者和49例对照组患者。44例患者（34.9%）有胃食管反流和酶增强的适应证，PPI平均日剂量为1mg/kg/天。PPI组有21例患者（16.7%）发生低镁血症，而对照组有1例患者（2%）发生低镁血症（p=0.097）。总体而言，接受长期PPI治疗的75例患者（59.6%）至少有一次肺部加重，而对照组有12例患者（24.5%）发生肺部加重（p<0.001）。两组之间低钙血症、低骨密度或艰难梭菌毒素阳性的发生率没有显著差异。
与对照组相比，PPI组肺部加重的风险更高。需要进一步研究来评估CF患者长期使用PPI相关的不良反应。
