摘要
目的系统评价质子泵抑制剂(PPI)的使用与艰难梭菌感染风险的相关性,为临床医生用药提供依据。方法计算机检索PubMed、The Cochrane Library(2015年8期)、Web of Science、Ovid、CBM、CNKI、VIP和Wan Fang Data,搜集有关PPI的使用与艰难梭菌感染风险相关性的病例-对照研究和队列研究,检索时限均为1990年1月至2015年10月。由2名研究者独立筛选文献、提取资料和评价纳入研究的偏倚风险后,采用RevMan 5.3软件进行Meta分析。结果共纳入47篇文献(50个研究),共计309 620例研究对象,其中病例组15 913例,对照组293 707例。Meta分析结果显示:使用PPI的患者艰难梭菌感染率明显高于没有使用PPI的患者,其差异有统计学意义[OR=1.99,95%CI(1.72,2.31),P<0.01,I2=87%]。进一步按文献类型、患者类型、样本量大小、NOS评分的不同进行的亚组分析结果均表明,使用PPI的患者艰难梭菌感染率明显高于没有使用PPI的患者,但并不能完全解释统计学异质性。结论使用PPI的患者艰难梭菌感染的风险是没有使用PPI患者的两倍,这一结论对公共健康和感染控制有重大意义,提示医生在使用PPI时应多关注其可能致艰难梭菌感染的风险性。
Objective To systematically review the association between use of proton pumps inhibitors（PPIs） and clostridium difficile infection（CDI）, so as to provide evidence for doctors’ prescription. Methods We electronically searched databases including Pub Med, The Cochrane Library（Issue 8, 2015）, Web of Science, Ovid, CBM, CNKI, VIP, Wan Fang Data to collect case-control studies and cohort studies about the association between use of PPIs and CDI from January 1990 to October 2015. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then meta-analysis was performed using RevMan 5.3 software. Results A total of 47 articles involving 50 studies with 309 620 cases were included. According to whether infected by clostridium difficile or not, these cases were divided into the case group（n=15 913） and the control group（n=293 707）. The result of meta-analysis showed that the CDI rate of the PPIs therapy group was higher than that of the control group（OR=1.99, 95%CI 1.72 to 2.31, P〈0.01, I2=87%） but a significant heterogeneity was found among studies. So subgroup analyses were performed according to the type of study design, type of patients, sample size and NOS scores of included studies. The results showed that, within different subgroups, the CDI rate of the PPIs therapy group was higher than that of the control group with significance, but the heterogeneity among studies was still existed. Conclusion Current evidence shows the use of PPI is associate with a 2-fold increase of the risk of CDI. Due to limited quality of the included studies, the above conclusion needs to be verified by more high quality studies.
出处
《中国循证医学杂志》
CSCD
2016年第3期278-285,共8页
Chinese Journal of Evidence-based Medicine
