JCEM:长期使用质子泵抑制剂与2型糖尿病风险的关系

2022-04-19 MedSci原创 MedSci原创

定期和长期使用PPIs与更高的糖尿病风险相关。因此,医生应避免不必要PPI药物处方,特别是长期使用。

质子泵抑制剂(PPIs)通过不可逆地抑制胃壁细胞的H+/K+ATP酶(或质子泵),长效抑制基础和食物刺激的胃酸分泌。由于这些药理特性,它们已成为酸相关疾病如胃食管反流病、Barrett食管和消化性溃疡患者的首选治疗方法,并在服用非甾体抗炎药(NSAIDs)时用于防止胃肠道出血。由于它们的功效,仿制药的引入,以及它们作为非处方药来使用,这些药物的市场在过去三十年中逐渐增长,质子泵抑制剂(PPIs)的长期使用是否会影响代谢健康仍存在争议。

近日,内分泌和代谢性疾病领域权威杂志Journal of Clinical Endocrinology & Metabolism上发表了一篇研究文章,该研究旨在探讨长时间使用PPIs与糖尿病发生风险之间的关系。

研究人员在意大利伦巴第进行了一项病例对照研究,研究对象为2010年至2015年期间新接受PPIs治疗的777420名患者。到2020年,共有50535例糖尿病患者与数量相等的对照者相匹配,这些对照组是根据年龄、性别和临床状态随机从队列成员中选择的。根据治疗时间,在病例对照组中评估了PPIs治疗的暴露情况。在调整了几个协变量后,研究人员拟合了一个条件logistic回归模型来估计暴露-结局相关性的比值比(OR)和95%置信区间(CI)。研究人员进行了敏感性分析,以评估研究结果的稳健性。

与使用PPIs<8周的患者相比,在使用PPIs为8周至6个月、6个月至2年和>2年的患者中,糖尿病发生率分别为19% (95%CI为15-24%)、43%(38-49%)和56%(49-64%)。当根据年龄、性别和临床特征进行分层分析时,结果是一致的,在年轻患者和临床复杂性较差的患者中发现较高的ORs。敏感性分析显示,相关性是一致且稳健的。

由此可见,定期和长期使用PPIs与更高的糖尿病风险相关。因此,医生应避免不必要PPI药物处方,特别是长期使用。

原始出处:

Stefano Ciardullo,et al.Prolonged use of proton pump inhibitors and risk of type 2 diabetes: results from a large population-based nested case-control study.JCEM.2022.https://academic.oup.com/jcem/advance-article/doi/10.1210/clinem/dgac231/6569190

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    2023-01-22 smallant2015
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    2022-12-11 jklm09
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    2022-08-15 achengzhao
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    2022-04-20 ms2000001188720592

    ***

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