Zhang Shengyu, Han Ziying, Zhang Yuelun, Gao Xiaomao, Zheng Shicheng, Wang Ruifeng, Wu Dong
State Key Laboratory of Complex Severe and Rare Diseases, Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Medical Research Center, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Front Pharmacol. 2021 Dec 14;12:772975. doi: 10.3389/fphar.2021.772975. eCollection 2021.
Acute pancreatitis (AP) is a systemic inflammatory disorder with a wide spectrum of clinical symptoms that can range from mild to severe. Previous preclinical study results suggest that proton pump inhibitors (PPIs) can inhibit exocrine pancreatic secretion and exert anti-inflammatory properties, which might in turn improve the outcome of AP. We conducted this multicenter, retrospective cohort study to investigate the potential effects of PPIs on the mortality, and total duration of hospital stay and local complication occurrence of patients with AP. A total of 858 patients with AP were included. All patients presented to the hospital within 48 h of symptom onset and were divided into the following two groups: patients who were treated with PPIs ( = 684) and those not treated with PPIs ( = 174). We used propensity score matching (PSM) analysis to reduce confounding bias before comparing the outcomes between the two groups. Before PSM analysis, there were significant differences in a number of parameters between the two groups, including age, sex, hematocrit, blood urea nitrogen, peritonitis signs, Ranson's score, and Acute Physiology Chronic Health Evaluation II score and organ failure occurrence. Before PSM, the PPIs group had a higher rate of mortality than the control group [RR = 1.065; 95% confidence ratio (CI) 1.045-1.086; = 0.001]. After PSM, there was no significant difference in mortality (RR = 1.009; 95% CI, 0.999-1.019; = 0.554) or total hospital stay ( = 0.856), although the PPIs group had a lower occurrence of pancreatic pseudocyst (RR = 0.416; 95% CI 0.221-0.780; = 0.005). This study showed that PPIs therapy was not associated with reduced mortality or total hospital stay, but was associated with a reduction in the occurrence of pseudocysts in patients with acute pancreatitis.
急性胰腺炎(AP)是一种具有广泛临床症状的全身性炎症性疾病,症状可轻可重。先前的临床前研究结果表明,质子泵抑制剂(PPI)可抑制胰腺外分泌并发挥抗炎特性,这可能进而改善AP的预后。我们开展了这项多中心回顾性队列研究,以调查PPI对AP患者死亡率、住院总时长及局部并发症发生情况的潜在影响。共纳入858例AP患者。所有患者均在症状发作后48小时内入院,并分为以下两组:接受PPI治疗的患者(n = 684)和未接受PPI治疗的患者(n = 174)。在比较两组结局之前,我们使用倾向评分匹配(PSM)分析以减少混杂偏倚。在PSM分析之前,两组之间在多个参数上存在显著差异,包括年龄、性别、血细胞比容、血尿素氮、腹膜炎体征、兰森评分、急性生理与慢性健康状况评估II评分以及器官衰竭的发生情况。在PSM之前,PPI组的死亡率高于对照组[相对危险度(RR)= 1.065;95%置信区间(CI)1.045 - 1.086;P = 0.001]。PSM之后,死亡率(RR = 1.009;95% CI,0.999 - 1.019;P = 0.554)或住院总时长(P = 0.856)无显著差异,尽管PPI组胰腺假性囊肿的发生率较低(RR = 0.416;95% CI 0.221 - 0.780;P = 0.005)。这项研究表明,PPI治疗与死亡率降低或住院总时长缩短无关,但与急性胰腺炎患者假性囊肿发生率降低有关。