质子泵抑制剂可降低 HFE 相关性血色病患者的采血负担：系统评价和荟萃分析。

Proton pump inhibitors reduce phlebotomy burden in patients with HFE-related hemochromatosis: a systematic review and meta-analysis.

机构信息

Division of Gastroenterology, Hepatology and Nutrition, University of Minnesota, Minneapolis, Minnesota.

Department of Internal Medicine, Seton Hall University, South Orange, New Jersey, USA.

出版信息

Eur J Gastroenterol Hepatol. 2021 Oct 1;33(10):1327-1331. doi: 10.1097/MEG.0000000000001857.

DOI:10.1097/MEG.0000000000001857

PMID:32769410

Abstract

BACKGROUND AND AIMS

Proton pump inhibitors (PPIs) may reduce iron absorption and serum ferritin levels in patients with homeostatic iron regulator (HFE)-related hemochromatosis, reducing the need for frequent phlebotomies. Our study aimed to perform for the first time a meta-analysis of existing observational and randomized controlled studies to ascertain the overall effect of PPI use in patients with HFE-related hemochromatosis.

METHODS

Studies in adults reporting the outcomes of PPIs use in hereditary hemochromatosis patients from Medline, Embase, Scopus and Google Scholar databases from inception to December 2019 were systematically searched. The study outcomes were the serum ferritin levels and annual requirement for phlebotomies. Pooled mean difference, and 95% confidence intervals (CIs) were obtained by the random-effects model. Forrest plots were constructed to show the summary pooled estimate. Heterogeneity was assessed by using I2 measure of inconsistency.

RESULTS

Following an initial search of 202 manuscripts, a total of three studies involving 68 patients with hemochromatosis (34 in the PPIs group and 34 in the placebo or non-PPI group) were included. A minimum duration of PPI use was 1 year. Patients who received PPIs therapy did not have a statistically significant lower serum ferritin levels (mean difference: -18.86, 95% CI: -60.44, 22.72, P = 0.37, I2 = 88%) but required significantly less sessions of phlebotomies annually (mean difference: -3.10, 95% CI: -4.46, -3.08, P < 0.00001, I2 = 93%). No publication bias was found on Egger (P = 0.94) or Begg (P = 0.98) tests.

CONCLUSION

PPIs can be used as an adjuvant therapy to reduce phlebotomy burden in patients with HFE-related hemochromatosis.

摘要

背景和目的

质子泵抑制剂 (PPI) 可能会降低稳态铁调节因子 (HFE) 相关血色病患者的铁吸收和血清铁蛋白水平，从而减少频繁放血的需求。我们的研究旨在首次对现有的观察性和随机对照研究进行荟萃分析，以确定 PPI 在 HFE 相关血色病患者中的总体使用效果。

方法

系统检索了从 Medline、Embase、Scopus 和 Google Scholar 数据库中收录的关于 PPI 在遗传性血色病患者中使用结果的成人研究，检索时间截至 2019 年 12 月。研究结果为血清铁蛋白水平和每年需要进行的放血次数。采用随机效应模型获得汇总平均差值和 95%置信区间 (CI)。通过森林图展示汇总的估计值。采用 I2 测量不一致性来评估异质性。

结果

经过对 202 篇手稿的初步搜索，共纳入了三项涉及 68 例血色病患者的研究（PPI 组 34 例，安慰剂或非 PPI 组 34 例）。PPI 治疗的最短疗程为 1 年。接受 PPI 治疗的患者血清铁蛋白水平无统计学显著降低（平均差值：-18.86，95%CI：-60.44，22.72，P=0.37，I2=88%），但每年需要进行的放血次数明显减少（平均差值：-3.10，95%CI：-4.46，-3.08，P<0.00001，I2=93%）。Egger（P=0.94）或 Begg（P=0.98）检验未发现发表偏倚。