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[BMJ发表论文]: 美国退伍军人使用质子泵抑制剂相关的全因病死率及疾病特异性病死率:队列研究
2019年06月24日 时讯速递, 进展交流 暂无评论

Research

Estimates of all cause mortality and cause specific mortality associated with proton pump inhibitors among US veterans: cohort study

BMJ 2019; 365: l1580 https://doi.org/10.1136/bmj.l1580

Abstract

Objective 目的

To estimate all cause mortality and cause specific mortality among patients taking proton pump inhibitors (PPIs).

估算服用质子泵抑制剂(PPI)患者的全因病死率及疾病特异性病死率。

Design 试验设计

Longitudinal observational cohort study.

纵向观察队列研究

Setting 场景

US Department of Veterans Affairs.

美国退伍军人事务部

Participants 研究对象

New users of PPIs (n=157 625) or H2 blockers (n=56 842).

新使用PPI (n=157 625) 或 H2 阻滞剂 (n=56 842) 的患者

Main outcome measures 主要预后指标

All cause mortality and cause specific mortality associated with taking PPIs (values reported as number of attributable deaths per 1000 patients taking PPIs).

与服用PPI相关的全因病死率及疾病特异性病死率(结果报告为每1000名服用PPI患者中归因死亡人数)

Results 结果

There were 45.20 excess deaths (95% confidence interval 28.20 to 61.40) per 1000 patients taking PPIs. Circulatory system diseases (number of attributable deaths per 1000 patients taking PPIs 17.47, 95% confidence interval 5.47 to 28.80), neoplasms (12.94, 1.24 to 24.28), infectious and parasitic diseases (4.20, 1.57 to 7.02), and genitourinary system diseases (6.25, 3.22 to 9.24) were associated with taking PPIs. There was a graded relation between cumulative duration of PPI exposure and the risk of all cause mortality and death due to circulatory system diseases, neoplasms, and genitourinary system diseases. Analyses of subcauses of death suggested that taking PPIs was associated with an excess mortality due to cardiovascular disease (15.48, 5.02 to 25.19) and chronic kidney disease (4.19, 1.56 to 6.58). Among patients without documented indication for acid suppression drugs (n=116 377), taking PPIs was associated with an excess mortality due to cardiovascular disease (22.91, 11.89 to 33.57), chronic kidney disease (4.74, 1.53 to 8.05), and upper gastrointestinal cancer (3.12, 0.91 to 5.44). Formal interaction analyses suggested that the risk of death due to these subcauses was not modified by a history of cardiovascular disease, chronic kidney disease, or upper gastrointestinal cancer. Taking PPIs was not associated with an excess burden of transportation related mortality and death due to peptic ulcer disease (as negative outcome controls).

每1000名服用PPI患者中额外死亡45.20例(95%可信区间 28.20 to 61.40)。循环系统疾病(每1000名服用PPI患者中归因死亡17.47例,95% 可信区间 5.47 to 28.80),肿瘤(12.94, 1.24 to 24.28),感染性和寄生虫性疾病(4.20, 1.57 to 7.02)及生殖泌尿系统疾病(6.25, 3.22 to 9.24)与服用PPI相关。全因病死率及循环系统疾病、肿瘤、感染性和寄生虫性疾病与生殖泌尿系统疾病导致的死亡均与PPI累积暴露时间具有等级相关性。对于各种病因导致死亡的分析提示,服用PPI伴随心血管疾病(15.48, 5.02 to 25.19)和慢性肾病(4.19, 1.56 to 6.58)导致的额外病死率增加。对于没有抑酸药物治疗指证的患者 (n=116 377),服用PPI伴随心血管疾病(22.91, 11.89 to 33.57),慢性肾病(4.74, 1.53 to 8.05)及上消化道肿瘤(3.12, 0.91 to 5.44)导致的额外病死率增加。交互作用分析提示,这些病因导致的死亡风险并不受心血管疾病、慢性肾病或上消化道肿瘤病史的影响。服用PPI与交通相关额外死亡和消化性溃疡病导致额外死亡无关(作为阴性预后对照)。

Conclusions 结论

Taking PPIs is associated with a small excess of cause specific mortality including death due to cardiovascular disease, chronic kidney disease, and upper gastrointestinal cancer. The burden was also observed in patients without an indication for PPI use. Heightened vigilance in the use of PPI may be warranted.

服用PPI伴随包括心血管疾病、慢性肾病和上消化道肿瘤在内的疾病特异性病死率轻度增加。没有使用PPI指证的患者也观察到同样现象。需要更加谨慎使用PPI。

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