Pulmonary and Critical Care Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA.
Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hamshire, USA.
Pediatr Pulmonol. 2021 Jul;56(7):2048-2056. doi: 10.1002/ppul.25431. Epub 2021 Apr 26.
Proton pump inhibitors (PPIs) and histamine H2-receptor antagonists (H2RAs) are commonly prescribed to people with cystic fibrosis (PwCF) to treat gastroesophageal reflux disease (GERD) and/or protect pancreatic enzymes from degradation in the stomach. Acid suppressive medications (ASMs) could theoretically reduce hemoglobin (Hgb) levels by restricting enteral iron absorption, but evidence of an association between use of ASMs and lower Hgb levels is lacking in PwCF.
We used unadjusted and covariate-adjusted generalized linear mixed models (GLMMs) to estimate the fixed effects of using versus never using ASMs on annual Hgb levels of PwCF in the U.S. Cystic Fibrosis Foundation Patient Registry (CFFPR) from 2011 to 2017.
There were 9850 users and 9007 never-users of ASMs from 2011 to 2017 who met inclusion criteria. Not adjusting for covariates, Hgb estimates were lower for male and female H2RA and/or PPI users versus never-users. Adjusting for covariates, mean Hgb was 0.1 g/dl (95% CI: 0.03, 0.17) lower for males that exclusively used PPIs than it was for male never-users of ASMs (p = .008). Adjusting for covariates, mean Hgb levels were 0.11 g/dl (95% CI: 0.04, 0.18) lower for females that exclusively used PPIs and 0.16 g/dl (95% CI: 0.05, 0.27) lower for females that used PPIs and H2RAs concurrently than it was for female never-users of ASMs (p = .005 and p = .002 for respective comparisons).
Males and females with cystic fibrosis (CF) who used PPIs and females with CF who concurrently used PPIs and H2RAs had lower Hgb levels than never-users of ASMs of the same sex in the CFFPR from 2011 to 2017.
质子泵抑制剂（PPIs）和组胺 H2 受体拮抗剂（H2RAs）常用于治疗囊性纤维化（CF）患者的胃食管反流病（GERD）和/或保护胰腺酶在胃中免受降解。酸抑制药物（ASM）理论上可以通过限制肠内铁吸收来降低血红蛋白（Hgb）水平，但在 CF 患者中，ASM 的使用与较低的 Hgb 水平之间缺乏关联的证据。
我们使用未经调整和协变量调整的广义线性混合模型（GLMM）来估计美国囊性纤维化基金会患者登记处（CFFPR）从 2011 年至 2017 年期间使用与从未使用过 ASM 的 CF 患者的年度 Hgb 水平的固定效应。
在 2011 年至 2017 年期间，符合纳入标准的有 9850 名 ASM 使用者和 9007 名从未使用者。未调整协变量时，与从未使用者相比，男性和女性 H2RA 和/或 PPI 使用者的 Hgb 估计值较低。调整协变量后，与从未使用过 ASM 的男性相比，仅使用 PPI 的男性的平均 Hgb 低 0.1g/dl（95%CI：0.03，0.17）（p=0.008）。调整协变量后，仅使用 PPI 的女性的平均 Hgb 水平低 0.11g/dl（95%CI：0.04，0.18），同时使用 PPI 和 H2RA 的女性低 0.16g/dl（95%CI：0.05，0.27）与从未使用过 ASM 的女性相比（分别为 p=0.005 和 p=0.002）。
在 2011 年至 2017 年期间，使用 PPI 的 CF 男性和女性以及同时使用 PPI 和 H2RA 的 CF 女性的 Hgb 水平低于 CFFPR 中同一性别从未使用过 ASM 的患者。
