质子泵抑制剂长期治疗后癫痫的风险。
The Risk of Epilepsy after Long-term Proton Pump Inhibitor Therapy.
机构信息
Department of Psychiatry, Beitou Branch, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan; Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan.
Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Psychiatry, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
出版信息
Seizure. 2021 Apr;87:88-93. doi: 10.1016/j.seizure.2021.03.008. Epub 2021 Mar 11.
BACKGROUND
Prescription-event monitoring studies have reported incident epilepsy or seizures in proton pump inhibitor (PPI) recipients. We examined the risk of epilepsy after prolonged PPI exposure and determine what age group was at higher risk of epilepsy.
METHODS
We performed a case-control study nested within a sample of Taiwan National Health Insurance beneficiaries (n = 1,000,000). PPI users with subsequent epilepsy were selected as the case cohort. Controls were PPI users without subsequent epilepsy, matched for age, sex, PPI use indication, enrollment time, end point time, follow-up period, overall systemic health, and comorbidities. The total dose of PPI was defined as the cumulative defined daily dose (cDDD). Prolonged PPI use was defined as a cDDD > 365. A logistic regression analysis was performed. Population attributable risk was calculated.
RESULTS
Epilepsy occurred 4.13 years after the initiation of PPI use. PPI users with the highest risk of incident epilepsy received a cDDD > 365 [odds ratio = 1.63, 95% confidence interval = 1.37-1.95], followed by 121-365 cDDD (1.33, 1.18-1.51) and 31-120 cDDD (1.15, 1.02-1.29), compared to those receiving a cDDD ≤ 30, after adjusting for potential confounders. Prolonged PPI use increased the risk of epilepsy in all age groups, and the risk was highest for those older than 80 years (3.11, 1.67-5.79). The population attributable risk was 12.2% (> 365 cDDD vs ≤ 30 cDDD).
DISCUSSION
Prolonged PPI therapy was associated with an increased risk of epilepsy, particularly in the elderly population.
背景
处方事件监测研究报告称质子泵抑制剂（PPI）使用者中出现了癫痫发作或癫痫。我们研究了长期使用 PPI 后发生癫痫的风险，并确定了哪个年龄段发生癫痫的风险更高。
方法
我们进行了一项病例对照研究，该研究嵌套在台湾全民健康保险受益人群体（n=100 万）的样本中。随后患有癫痫的 PPI 使用者被选为病例队列。对照组为随后未患有癫痫的 PPI 使用者，按年龄、性别、PPI 使用指征、入组时间、终点时间、随访期、整体全身健康状况和合并症进行匹配。PPI 的总剂量定义为累积定义日剂量（cDDD）。长期 PPI 使用定义为 cDDD > 365。进行了 logistic 回归分析。计算了人群归因风险。
结果
癫痫在 PPI 使用开始后 4.13 年发生。接受 PPI 治疗后癫痫发病风险最高的是接受 cDDD > 365 的患者[比值比（OR）=1.63，95%置信区间（CI）=1.37-1.95]，其次是 cDDD 为 121-365 的患者（1.33，1.18-1.51）和 cDDD 为 31-120 的患者（1.15，1.02-1.29），与接受 cDDD ≤ 30 的患者相比，调整了潜在混杂因素后。长期使用 PPI 增加了所有年龄段的癫痫发病风险，年龄大于 80 岁的患者风险最高（3.11，1.67-5.79）。人群归因风险为 12.2%（cDDD > 365 与 cDDD ≤ 30 相比）。
讨论
长期 PPI 治疗与癫痫风险增加相关，尤其是在老年人群中。
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