摘要
目的系统评价使用不同抑酸剂时医院获得性艰难梭菌感染的风险,为临床医生选择抑酸剂提供依据。方法计算机检索PubMed、EMBASE、The Cochrane Library、CNKI、WanFang Data、CBM和VIP等数据库,搜集有关质子泵抑制剂(PPI)、组胺-2受体拮抗剂(H2RA)与医院获得性艰难梭菌感染风险相关性的文献,使用Stata 12.0软件进行Meta分析。结果共有14篇符合纳入标准的文献,其中病例-对照研究10篇,队列研究4篇。Meta分析结果显示,使用PPI的患者医院获得性艰难梭菌感染风险比使用H2RA的患者高33.1%,差异具有统计学意义[OR=1.331,95%CI(1.185~1.496),P<0.01]。进一步按研究类型、用药目的的不同进行了亚组分析,结果均表明使用PPI的患者医院获得性艰难梭菌感染率明显高于使用H2RA的患者。使用漏斗图、Egger's法和Begg's法进行发表偏倚检测,结果表明纳入的研究均不存在发表偏倚。敏感性分析结果发现,异质性可能来源于Dubberke的研究,排除Dubberke的研究后再重新进行整合分析,异质性较前下降明显,并且合并OR值较前增大。结论使用PPI的患者医院获得性艰难梭菌感染风险比使用H2RA的患者高33.1%。
Objective To systematically evaluate the risk of hospital-acquired Clostridium difficile infection associated with use of different antacids,and provide evidence for clinicians to choose appropriate antacid.Methods PubMed,EMBASE,Cochrane Library,CNKI,WanFang Data,CBM and VIP databases were searched to retrieve the literatures on the correlations of proton pump inhibitors and histamine-2 receptor antagonists with the risk of hospital-acquired C. difficile infection.Meta-analysis was performed using Stata 12.0 software.Results A total of 14 articles were included,including 10 case-control studies and 4 cohort studies.Meta-analysis showed that the risk of hospital-acquired C. difficile infection in patients using PPIs was significantly higher than in those using H2RAs[OR=1.331,95%CI(1.185 - 1.496),P<0.001].Further analysis of subgroups by type of study and purpose of use of the drugs showed that the incidence rate of hospital-acquired C. difficile infection in patients using PPIs was significantly higher than in those using H2RAs.The publication bias test by using the funnel plot,Egger's method and Begg's method showed that there was no publication bias in the included studies.Sensitivity analysis found that the heterogeneity possibly came from Dubberke's study.After Dubberke's study was excluded and the integration analysis was completed,the heterogeneity decreased significantly,and the combined OR value increased.Conclusion Patients accepting PPIs had a 33.1% higher risk of hospital-acquired C. difficile infection than those accepting H2RAs.
作者
罗晓亮
宋睿
杜国平
LUO Xiaoliang;SONG Rui;DU Guoping(Guangdong Medical University,Zhanjiang,Guangdong 524023,China)
出处
《中国微生态学杂志》
CAS
CSCD
2018年第12期1408-1413,共6页
Chinese Journal of Microecology
