Fasullo Matthew, Rau Prashanth, Liu Dong-Qi, Holzwanger Erik, Mathew Jomol P, Guilarte-Walker Yurima, Szabo Gyongyi
Department of Medicine, University of Massachusetts Medical School, Worcester, MA 01605, United States.
Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA 01605, United States.
World J Hepatol. 2019 Jun 27;11(6):522-530. doi: 10.4254/wjh.v11.i6.522.
Liver cirrhosis is the late stage of hepatic fibrosis and is characterized by portal hypertension that can clinically lead to decompensation in the form of ascites, esophageal/gastric varices or encephalopathy. The most common sequelae associated with liver cirrhosis are neurologic and neuropsychiatric impairments labeled as hepatic encephalopathy (HE). Well established triggers for HE include infection, gastrointestinal bleeding, constipation, and medications. Alterations to the gut microbiome is one of the leading ammonia producers in the body, and therefore may make patients more susceptible to HE.
To investigate the relationship between the use of proton pump inhibitors (PPIs) and HE in patients with cirrhosis.
This is a single center, retrospective analysis. Patients were included in the study with an admitting diagnosis of HE. The degree of HE was determined from subjective and objective portions of hospital admission notes using the West Haven Criteria. The primary outcome of the study was to evaluate the grade of HE in PPI users non-users at admission to the hospital and throughout their hospital course. Secondary outcomes included rate of infection, gastrointestinal bleeding within the last 12 mo, mean ammonia level, and model for end-stage liver disease scores at admission.
The HE grade at admission using the West Haven Criteria was 2.3 in the PPI group compared to 1.7 in the PPI nonuser group ( 0.001). The average length of hospital stay in PPI group was 8.3 d compared to 6.5 d in PPI nonusers ( 0.046). Twenty-seven (31.8%) patients in the PPI user group required an Intensive Care Unit admission during their hospital course compared to 6 in the PPI nonuser group (16.7%) ( 0.138). Finally, 10 (11.8%) patients in the PPI group expired during their hospital stay compared to 1 in the PPI nonuser group (2.8%) ( 0.220).
Chronic PPI use in cirrhotic patients is associated with significantly higher average West Haven Criteria for HE compared to patients that do not use PPIs.
肝硬化是肝纤维化的晚期阶段，其特征为门静脉高压，临床上可导致腹水、食管/胃静脉曲张或肝性脑病等失代偿形式。与肝硬化相关的最常见后遗症是被称为肝性脑病（HE）的神经和神经精神障碍。公认的HE诱因包括感染、胃肠道出血、便秘和药物。肠道微生物群的改变是体内主要的氨产生源之一，因此可能使患者更容易发生HE。
研究质子泵抑制剂（PPI）的使用与肝硬化患者HE之间的关系。
这是一项单中心回顾性分析。纳入研究的患者入院诊断为HE。根据西黑文标准，通过入院记录的主观和客观部分确定HE的程度。研究的主要结局是评估入院时及整个住院期间PPI使用者与非使用者的HE分级。次要结局包括感染率、过去12个月内的胃肠道出血、平均氨水平以及入院时的终末期肝病模型评分。
根据西黑文标准，PPI组入院时的HE分级为2.3，而PPI非使用者组为1.7（P<0.001）。PPI组的平均住院时间为8.3天，而PPI非使用者组为6.5天（P=0.046）。PPI使用者组中有27例（31.8%）患者在住院期间需要入住重症监护病房，而PPI非使用者组为6例（16.7%）（P=0.138）。最后，PPI组中有10例（11.8%）患者在住院期间死亡，而PPI非使用者组为1例（2.8%）（P=0.220）。
与未使用PPI的患者相比，肝硬化患者长期使用PPI与HE的平均西黑文标准显著更高相关。
