Zhu Jia, Qi Xingshun, Yu Haonan, Yoshida Eric M, Mendez-Sanchez Nahum, Zhang Xintong, Wang Ran, Deng Han, Li Jing, Han Dan, Guo Xiaozhong
Liver Cirrhosis Study Group, Department of Gastroenterology, General Hospital of Shenyang Military Area, Shenyang, China.
Postgraduate College, Shenyang Pharmaceutical University, Shenyang, China.
United European Gastroenterol J. 2018 Oct;6(8):1179-1187. doi: 10.1177/2050640618773564. Epub 2018 Apr 23.
Hepatic encephalopathy is associated with altered gut microbiota. Proton pump inhibitors increase the risk of small bowel bacterial overgrowth.
This was a case-control study aimed at exploring the relationship of proton pump inhibitor use with the risk of hepatic encephalopathy during hospitalization in liver cirrhosis.
Case and control groups were defined as cirrhotic patients who developed hepatic encephalopathy during hospitalization and those without hepatic encephalopathy at admission or during hospitalization, respectively. Age, gender, and Child-Pugh score were matched between the groups. Odds ratios with 95% confidence intervals were calculated to express the association of proton pump inhibitors with the risk of hepatic encephalopathy. Four subgroup analyses were performed after excluding patients with acute upper gastrointestinal bleeding, infections, and in-hospital death, and after matching model for end-stage liver disease score.
In the overall analysis, 128 patients were included in each group of cases and controls. The proportion of proton pump inhibitor use was significantly higher in the case group than the control group (79.7% vs 43%, < 0.001). Proton pump inhibitor use (odds ratio = 3.481, 95% confidence interval: 1.651-7.340, = 0.001) was independently associated with the development of hepatic encephalopathy in the multivariate analysis. In the four subgroup analyses, proton pump inhibitor use remained independently associated with the risk of hepatic encephalopathy.
Proton pump inhibitor use might increase the risk of hepatic encephalopathy during hospitalization.
肝性脑病与肠道微生物群改变有关。质子泵抑制剂会增加小肠细菌过度生长的风险。
这是一项病例对照研究，旨在探讨在肝硬化住院期间使用质子泵抑制剂与肝性脑病风险之间的关系。
病例组和对照组分别定义为住院期间发生肝性脑病的肝硬化患者以及入院时或住院期间未发生肝性脑病的患者。两组在年龄、性别和Child-Pugh评分方面进行匹配。计算比值比及其95%置信区间，以表达质子泵抑制剂与肝性脑病风险之间的关联。在排除急性上消化道出血、感染和院内死亡患者后，以及在匹配终末期肝病评分模型后，进行了四项亚组分析。
在总体分析中，病例组和对照组每组各纳入128例患者。病例组中使用质子泵抑制剂的比例显著高于对照组（79.7%对43%，<0.001）。在多变量分析中，使用质子泵抑制剂（比值比=3.481，95%置信区间：1.651-7.340，P=0.001）与肝性脑病的发生独立相关。在四项亚组分析中，使用质子泵抑制剂仍与肝性脑病风险独立相关。
使用质子泵抑制剂可能会增加住院期间发生肝性脑病的风险。
