质子泵抑制剂的使用与肝性脑病风险：一项多中心研究。
Proton pump inhibitor use and risk of hepatic encephalopathy: A multicentre study.
作者信息
Gairing Simon Johannes, Mangini Chiara, Zarantonello Lisa, Jonasson Elise, Dobbermann Henrike, Sultanik Philippe, Galle Peter Robert, Labenz Joachim, Thabut Dominique, Marquardt Jens Uwe, Bloom Patricia P, Lauridsen Mette Munk, Montagnese Sara, Labenz Christian
机构信息
Department of Internal Medicine I, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany.
Cirrhosis Center Mainz (CCM), University Medical Center of the Johannes Gutenberg-University, Mainz, Germany.
出版信息
JHEP Rep. 2024 Apr 26;6(8):101104. doi: 10.1016/j.jhepr.2024.101104. eCollection 2024 Aug.
BACKGROUND & AIMS: Data on the association between proton pump inhibitor (PPI) use and hepatic encephalopathy (HE) are conflicting, and data from multicentre studies are scarce. The aim of this study was to dissect the potential association between PPI use and minimal (MHE) and overt HE (OHE).
METHODS
Data from patients with cirrhosis recruited at seven centres across Europe and the US were analysed. MHE was defined by the psychometric hepatic encephalopathy score (PHES). PPI use was recorded on the day of testing with PHES. Patients were followed for OHE development and death/liver transplantation.
RESULTS
A total of 1,160 patients with a median MELD of 11 were included (Child-Pugh stages: A 49%/B 39%/C 11%). PPI use was noted in 58% of patients. Median follow-up time was 18.1 months, during which 230 (20%) developed an OHE episode, and 224 (19%) reached the composite endpoint of death/liver transplantation. In multivariable analyses, PPI use was neither associated with the presence of MHE at baseline nor OHE development during follow-up. These findings were consistent in subgroup analyses of patients with Child-Pugh A or B cirrhosis and after excluding patients with a history of OHE. PPI use was also not associated with a higher risk of OHE, neither in patients with an indication for treatment nor in patients without an indication.
CONCLUSIONS
PPI use is not associated with a higher risk of HE in patients with cirrhosis. Based on these findings, at present, a prescription should not be prohibited in case of a generally accepted indication.
IMPACT AND IMPLICATIONS
Data on the association between proton pump inhibitor (PPI) use and hepatic encephalopathy (HE) are conflicting. In this study, PPI use was not associated with a higher risk of minimal HE at baseline or overt HE during follow-up in patients with cirrhosis. Based on these findings, prescription of a PPI for a generally accepted indication should not be prohibited in patients with cirrhosis.
背景与目的
关于质子泵抑制剂（PPI）使用与肝性脑病（HE）之间关联的数据相互矛盾，且多中心研究的数据稀缺。本研究旨在剖析PPI使用与轻微肝性脑病（MHE）及显性肝性脑病（OHE）之间的潜在关联。
方法
对在欧洲和美国七个中心招募的肝硬化患者的数据进行分析。MHE由心理测量肝性脑病评分（PHES）定义。在进行PHES测试当天记录PPI的使用情况。对患者进行随访，观察OHE的发生及死亡/肝移植情况。
结果
共纳入1160例患者，中位终末期肝病模型（MELD）评分为11（Child-Pugh分级：A 级49%/B级39%/C级11%）。58%的患者使用了PPI。中位随访时间为18.1个月，在此期间，230例（20%）发生了OHE事件，224例（19%）达到了死亡/肝移植的复合终点。在多变量分析中，PPI的使用既与基线时MHE的存在无关，也与随访期间OHE的发生无关。这些发现在Child-Pugh A或B级肝硬化患者的亚组分析中以及排除有OHE病史的患者后均一致。PPI的使用也与OHE的较高风险无关，无论是在有治疗指征的患者还是无治疗指征的患者中。
结论
肝硬化患者使用PPI与HE的较高风险无关。基于这些发现，目前在有普遍认可的指征时不应禁止开具PPI处方。
影响与意义
关于质子泵抑制剂（PPI）使用与肝性脑病（HE）之间关联的数据相互矛盾。在本研究中，肝硬化患者使用PPI与基线时轻微肝性脑病的较高风险或随访期间显性肝性脑病的较高风险均无关。基于这些发现，对于有普遍认可指征的肝硬化患者，不应禁止开具PPI处方。
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