Department of Clinical Medicine and Surgery, Gastroenterology, University Federico II, Naples, Italy.
Medical Statistics Unit, University of Campania "Luigi Vanvitelli", Naples, Italy.
Aliment Pharmacol Ther. 2021 Mar;53(5):608-615. doi: 10.1111/apt.16239. Epub 2020 Dec 28.
Chronic use of proton pump inhibitors (PPIs) in patients with impaired liver function may worsen cytochrome P450 (CYP450) activity, predisposing them to clinically relevant drug-drug interactions. The C-aminopyrine breath test ( C-ABT) is a non-invasive tool to study CYP450-dependent liver function.
To assess C-ABT modifications with different PPIs in patients with cirrhosis METHODS: Sixty consecutive patients with HCV-related cirrhosis and indication to start PPI therapy were randomised to receive omeprazole 20 mg/day, esomeprazole 20 mg/day, lansoprazole 15 mg/day, pantoprazole 40 mg/day or rabeprazole 20 mg/day. C-ABT was performed at baseline and on the 15th day of PPI therapy.
At baseline, mean values of max C% dose/h and C% cum dose at 120 minutes did not differ significantly among groups. On the 15th day of therapy, max C% dose/h and C% cum dose at 120 minutes did not significantly differ with respect to baseline for pantoprazole (P = 0.184 and P = 0.309, respectively) or rabeprazole (P = 0.536 and P = 0.286, respectively), but were significantly decreased on omeprazole (P = 0.013 and P = 0.015, respectively), esomeprazole (P = 0.009 and P = 0.001, respectively), and lansoprazole (P = 0.033 and P = 0.035, respectively).
In patients with cirrhosis, omeprazole, esomeprazole and lansoprazole inhibit microsomal activity while pantoprazole and rabeprazole do not have a significant impact. Should our data be confirmed in larger cohort studies, pantoprazole and rabeprazole could be safely recommended for patients with cirrhosis.
在肝功能受损的患者中，长期使用质子泵抑制剂（PPIs）可能会加重细胞色素 P450（CYP450）活性，使他们易发生具有临床相关性的药物相互作用。C-氨基比林呼吸试验（C-ABT）是一种用于研究 CYP450 依赖性肝功能的非侵入性工具。
评估不同质子泵抑制剂（PPIs）在肝硬化患者中对 C-ABT 的影响。
60 例丙型肝炎相关肝硬化且需要开始 PPI 治疗的连续患者被随机分为接受奥美拉唑 20mg/天、埃索美拉唑 20mg/天、兰索拉唑 15mg/天、泮托拉唑 40mg/天或雷贝拉唑 20mg/天。在基线和 PPI 治疗的第 15 天进行 C-ABT。
在基线时，各组的最大 C%剂量/小时和 120 分钟时的 C%累积剂量的平均值无显著差异。在治疗的第 15 天，与基线相比，泮托拉唑或雷贝拉唑的最大 C%剂量/小时和 120 分钟时的 C%累积剂量无显著差异（分别为 P=0.184 和 P=0.309，P=0.536 和 P=0.286），但奥美拉唑（P=0.013 和 P=0.015）、埃索美拉唑（P=0.009 和 P=0.001）和兰索拉唑（P=0.033 和 P=0.035）的这些值显著降低。
在肝硬化患者中，奥美拉唑、埃索美拉唑和兰索拉唑抑制微粒体活性，而泮托拉唑和雷贝拉唑则没有显著影响。如果我们的数据在更大的队列研究中得到证实，泮托拉唑和雷贝拉唑可以安全地推荐给肝硬化患者。
