Shenzhen, China.
Boston, MA, USA.
Aliment Pharmacol Ther. 2020 Aug;52(3):449-458. doi: 10.1111/apt.15834. Epub 2020 Jun 29.
Proton pump inhibitors (PPIs) have a significant impact on the gut microbiome, which in turn, might increase the risk of rheumatoid arthritis (RA).
To evaluate regular use of PPIs and risk of RA.
This is a prospective analysis of the US nurses who reported PPI use data, and were free of RA from the Nurses' Health Study (NHS 2002-2014) and NHS II (2003-2015). The exposure was regular use of PPI in the past 2 years, which was repeatedly evaluated in biennial surveys. RA was confirmed by the 1987 or 2010 American College of Rheumatology criteria. We estimated the hazard ratios (HRs) and confidence interval (CIs) with time-dependent Cox regression adjusting for potential confounders.
We documented 421 cases of RA over 1 753 879 person-years of follow-up. Regular PPI users had a 44% higher risk of RA as compared with non-regular users (adjusted HR = 1.44; 95%CI, 1.10-1.89). The risk of RA increased with the total duration of PPI use (P-trend = 0.008). Compared with non-regular users, the adjusted HRs were 1.22 (95%CI, 0.93-1.62) for women with >0 to 4 years' use and 1.73 (95% CI, 1.14 to 2.61) for >4 years' use.
Regular use of PPI was associated with increased risk of RA in women, with a higher risk observed in individuals with a longer duration of PPI use. Due to the observational study design, large prospective trials are still required to confirm our finding.
质子泵抑制剂 (PPIs) 对肠道微生物群有显著影响，而肠道微生物群反过来又可能增加类风湿关节炎 (RA) 的风险。
评估常规使用质子泵抑制剂与 RA 风险的关系。
这是一项针对美国护士的前瞻性分析，这些护士在护士健康研究 (NHS 2002-2014 年) 和 NHS II (2003-2015 年) 期间报告了质子泵抑制剂的使用数据，且无 RA 病史。暴露因素为过去 2 年内常规使用质子泵抑制剂，该因素在每两年一次的调查中反复评估。RA 通过 1987 年或 2010 年美国风湿病学会标准进行确诊。我们使用时间依赖性 Cox 回归调整潜在混杂因素，估计了危险比 (HR) 和置信区间 (CI)。
在 1753879 人年的随访中，我们共记录了 421 例 RA 病例。与非常规使用者相比，常规使用质子泵抑制剂者发生 RA 的风险增加了 44%（校正 HR=1.44；95%CI，1.10-1.89）。RA 的发病风险随质子泵抑制剂使用总时长的增加而增加（P 趋势=0.008）。与非常规使用者相比，使用时间>0 至 4 年者校正后的 HR 为 1.22（95%CI，0.93-1.62），使用时间>4 年者校正后的 HR 为 1.73（95%CI，1.14-2.61）。
女性常规使用质子泵抑制剂与 RA 风险增加相关，且在使用质子泵抑制剂时间较长的个体中观察到更高的风险。由于本研究为观察性研究设计，仍需开展大型前瞻性试验来证实我们的发现。
