Srinutta Thawin, Chewcharat Api, Takkavatakarn Kullaya, Praditpornsilpa Kearkiat, Eiam-Ong Somchai, Jaber Bertrand L, Susantitaphong Paweena
Division of Nephrology, Department of Medicine, King Chulalongkorn Memorial Hospital, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
Department of Medicine, St. Elizabeth's Medical Center.
Medicine (Baltimore). 2019 Nov;98(44):e17788. doi: 10.1097/MD.0000000000017788.
Previous meta-analyses have suggested that there might be an association between the use of proton pump inhibitors (PPIs) and the development of hypomagnesemia, although the conclusions were no definitive.
To provide an update on this topic, we performed a meta-analysis of all observational studies that examined the association between the use of PPIs and the development of hypomagnesemia. A literature search was conducted in MEDLINE, Scopus and Cochrane Central Register of Controlled Trials (January 1970 to June 2018) to identify observational studies that examined the association between the use of PPIs and the incidence and prevalence of hypomagnesemia.
In the absence of randomized controlled trials, we focused primarily on observational studies, including cross-sectional, case-control, retrospective, and prospective cohort studies. There was no limitation on sample size or study duration. Random-effect models meta-analyses were used to compute pooled unadjusted and adjusted odds ratios (ORs) for binary variables.
Sixteen observational studies were identified, including 13 cross-sectional studies, 2 case-control studies, and 1 cohort study, with a total of 131,507 patients. The pooled percentage of PPI users was 43.6% (95% confidence interval [CI] 25.0%, 64.0%). Among PPI users, 19.4% (95% CI 13.8%, 26.5%) had hypomagnesemia compared to 13.5% (95% CI 7.9%, 22.2%) among nonusers. By meta-analysis, PPI use was significantly associated with hypomagnesemia, with a pooled unadjusted OR of 1.83 (95% CI 1.26, 2.67; P = .002) and a pooled adjusted OR of 1.71 (95% CI 1.33, 2.19; P < .001). In subgroup analyses, high-dose PPI use was associated with higher odds for hypomagnesemia relative to low-dose PPI use (pooled adjusted OR 2.13; 95% CI 1.26, 3.59; P = .005).
Our findings are in support of the results of the previous meta-analyses. Furthermore, we found a dose-response between the PPI use and development of hypomagnesemia.
既往的荟萃分析提示，质子泵抑制剂（PPI）的使用与低镁血症的发生之间可能存在关联，尽管结论并不明确。
为了提供该主题的最新信息，我们对所有检验PPI使用与低镁血症发生之间关联的观察性研究进行了荟萃分析。在MEDLINE、Scopus和Cochrane对照试验中央注册库（1970年1月至2018年6月）中进行文献检索，以识别检验PPI使用与低镁血症发病率和患病率之间关联的观察性研究。
由于缺乏随机对照试验，我们主要关注观察性研究，包括横断面研究、病例对照研究、回顾性研究和前瞻性队列研究。对样本量或研究持续时间没有限制。采用随机效应模型荟萃分析来计算二元变量的合并未调整和调整比值比（OR）。
共识别出16项观察性研究，包括13项横断面研究、2项病例对照研究和1项队列研究，共计131,507例患者。PPI使用者的合并百分比为43.6%（95%置信区间[CI]25.0%，64.0%）。在PPI使用者中，19.4%（95%CI 13.8%，26.5%）患有低镁血症，而非使用者中这一比例为13.5%（95%CI 7.9%，22.2%）。通过荟萃分析，PPI的使用与低镁血症显著相关，合并未调整OR为1.83（95%CI 1.26，2.67；P = 0.002），合并调整OR为1.71（95%CI 1.33，2.19；P < 0.001）。在亚组分析中，与低剂量PPI使用相比，高剂量PPI使用与低镁血症的较高几率相关（合并调整OR 2.13；95%CI 1.26，3.59；P = 0.005）。
我们的研究结果支持既往荟萃分析的结果。此外，我们发现PPI使用与低镁血症发生之间存在剂量反应关系。
