摘要
目的评价晚期肝病患者使用质子泵抑制剂(PPI)与发生肝性脑病(HE)风险的相关性。方法检索从数据库建立之日起到2019年12月31日PubMed、EMBASE、中国知网和Cochrane四个数据库,查找涉及使用PPI和发生HE风险相关性的研究文献,从纳入的文献中提取数据,使用随机效应模型做汇总风险评估和相应的95%置信区间(CI),并行敏感性分析及亚组分析。结果本次Meat分析纳入了7项研究的5088例患者,Meta分析结果表明,与非PPI使用者相比,晚期肝病患者使用PPI发生HE的风险升高,差异具有统计学意义[RR=2.00,95%Cl=(1.53-2.61),P<0.01,I^2=57%];在以不同研究类型进行的亚组分析中,病例对照研究组[RR=2.14,95%Cl=(1.47-3.10),P<0.01,I^2=49%]、队列研究组[RR=1.91,95%Cl=(1.21-3.02),P<0.01,I^2=73%];在以PPI使用定义进行的亚组分析中,住院期间使用PPI组[RR=3.51,95%Cl=(2.32-5.31),P<0.01,I^2=0%]、入院前使用PPI组[RR=1.60,95%Cl=(1.34-1.91),P<0.01,I^2=0%];基于不同肝病类型进行的亚组分析中,肝硬化组[RR=1.98,95%Cl=(1.44-2.70),P<0.01,I^2=28%]、肝硬化合并腹水组[RR=1.48,95%Cl=(1.17-1.86),P<0.01,I^2=0%]、其它组[RR=3.53,95%Cl=(2.15-5.80),P<0.01,I^2=0%];亚组分析结果表明,除基于研究设计类型的亚组存在高度异质性外,其余各亚组均未见明显异质性,且PPI组的HE风险仍然存在,提示Meta分析的结果稳定可靠。结论现有证据表明,晚期肝病患者使用PPI会增加发生HE的风险,因此在没有明确PPI适应症的情况下临床医生应慎重为晚期肝病患者使用PPI,这一结果仍需更多大样本、多中心研究来证实这种相关性。
Objective To investigate the correlation between the use of proton pump inhibitors(PPI)and the risk of hepatic encephalopathy(HE)in patients with advanced liver disease.Methods Search the four databases of PubMed,EMBASE,China HowNet,and Cochrane from the date of database establishment to December 31,2019 to find the research literature related to the use of PPI and the occurrence of HE risk.The random effects model does a pooled risk assessment and corresponding 95%confidence interval(CI),parallel sensitivity analysis,and subgroup analysis.Results This Meat analysis included 5088 patients from 7 studies.The results of the Meta analysis showed that compared with non-PPI users,patients with advanced liver disease had an increased risk of HE using PPI,and the difference was statistically significant[RR=2.00,95%Cl=(1.53-2.61),P<0.01,I^2=57%];in the subgroup analysis of different research types,the case-control study group[RR=2.14,95%Cl=(1.47-3.10),P<0.01,I^2=49%],cohort study group[RR=1.91,95%Cl=(1.21-3.02),P<0.01,I^2=73%];in the subgroup analysis with the definition of PPI usage,Use PPI group during hospitalization[RR=3.51,95%Cl=(2.32-5.31),P<0.01,I^2=0%],use PPI group before admission[RR=1.60,95%Cl=(1.34-1.91),P<0.01,I^2=0%];in the subgroup analysis based on different liver disease types,the liver cirrhosis group[RR=1.98,95%Cl=(1.44-2.70),P<0.01,I^2=28%],liver Sclerosis combined with ascites group[RR=1.48,95%Cl=(1.17-1.86),P<0.01,I^2=0%],other groups[RR=3.53,95%Cl=(2.15-5.80),P<0.01,I^2=0%];The results of subgroup analysis show that,except based on the type of study designExcept for the high degree of heterogeneity in the subgroups,there is no obvious heterogeneity in the other subgroups,and the risk of HE in the PPI group still exists,indicating that the results of the Meta analysis are stable and reliable.Conclusion Existing evidence indicates that the use of PPI in patients with advanced liver disease increases the risk of HE.Therefore,clinicians should be careful to use PPI for patients with advanced liver dise
作者
陈旭
李京涛
周振国
闫曙光
魏海梁
张毅
CHEN Xu;LI Jing-tao;ZHOU Zhen-guo;YAN Shu-guang;WEI Hai-liang;ZHANG Yi(Shaanxi University of Traditional Chinese Medicine,712046;Department of Liver Diseases,Affiliated Hospital of Shaanxi University of Traditional Chinese Medicine,712046;Department of Brain Surgery,Affiliated Hospital of Shaanxi University of Traditional Chinese Medicine,712046;First General Surgery,Affiliated Hospital of Shaanxi University of Traditional Chinese Medicin,712046)
出处
《现代消化及介入诊疗》
2020年第7期871-876,882,共7页
Modern Interventional Diagnosis and Treatment in Gastroenterology
基金
国家自然科学基金(81873288)
陕西省重点研发计划(2019SF-309)
陕西省重点研发计划(2018SF-311)
陕西省中医脑病临床医学研究中心建设项目(201704)
陕西中医药大学一流学科创新团队(2019-YL05)。
关键词
质子泵抑制剂
肝性脑病
晚期肝病
肝硬化
META分析
Proton pump inhibitor
Hepatic encephalopathy
Advanced liver disease
Cirrhosis
Meta-analysis
