JASN:质子泵抑制剂的使用会增加肾病风险再获证据

2016-04-16 MedSci MedSci原创

密苏里州圣路易斯卫生保健所研究人员通过对VA国家数据库中的数据进行分析后指出,若民众长期使用质子泵抑制剂用于治疗胃灼热、胃酸返流和胃溃疡,则可能会导致肾脏损害和严重的肾脏疾病的发生。研究结果发表在JASN。 质子泵抑制剂(PPIs)是目前治疗消化性溃疡最先进的一类药物,它通过高效快速抑制胃酸分泌和清除幽门螺旋杆菌达到快速治愈溃疡可减少胃酸由腺胃粘膜。它们通常可缓解胃酸反流症状或减轻胃食管反流病(G

密苏里州圣路易斯卫生保健所研究人员通过对VA国家数据库中的数据进行分析后指出,若民众长期使用质子泵抑制剂用于治疗胃灼热、胃酸返流和胃溃疡,则可能会导致肾脏损害和严重的肾脏疾病的发生。研究结果发表在JASN。 


质子泵抑制剂(PPIs)是目前治疗消化性溃疡最先进的一类药物,它通过高效快速抑制胃酸分泌和清除幽门螺旋杆菌达到快速治愈溃疡可减少胃酸由腺胃粘膜。它们通常可缓解胃酸反流症状或减轻胃食管反流病(GERD)患者的痛苦。质子泵抑制剂也可用于治疗消化性胃溃疡和由胃酸反流引起的食管损伤。质子泵抑制剂有许多种类和生产厂家,副作用也不尽相同,且为非处方药物。PPI的常见类型包括奥美拉唑、埃索美拉唑、兰索拉唑、雷贝拉唑、泮托拉唑、石兰索拉唑等。
2013年美国约有1500万人获得允许使用质子泵抑制剂,但研究人员认为使用PPIs的人数或需更多,因为该药物为非处方药物。 

在他们的研究中,研究人员研究了VA数据库近5年的数据信息,包括173000名新近使用质子泵抑制剂的患者和20000名新近使用H2受体阻滞剂的患者的数据信息。 

分析指出,服用质子泵抑制剂的患者比服用H2受体阻滞剂的患者更易出现肾功能减退和恶化。相比使用H2受体阻滞剂的患者而言,使用PPIs的患者患慢性肾病的风险增加28%,发展为肾衰竭的风险增加96%。

研究人员指出,PPIs服用的时间越长,患者出现肾脏问题的风险就越高。因此他们认为,长期使用质子泵抑制剂可能对患者的肾脏功能造成伤害。 

密苏里州圣路易斯卫生保健所的Ziyad Al-Aly认为这个发现十分重要。他强调必须严格规范质子泵抑制剂的使用,并限制使用的时间且最大可能缩短PPIs的使用。 

这项研究结果与此前一项研究结果结论一致:JAMA Intern Med:质子泵抑制剂(PPIs)与慢性肾脏疾病风险有关。在这项研究中,研究者定量分析了PPI使用和CKD风险间联系,研究对象暴露ARIC研究纳入的10482名参与者,中位数随访近14年;还有宾夕法尼亚州Geisinger卫生系统的门诊PPI处方研究,涉及248751名参与者,中位数随访6年。

在基线水平,两组使用PPI的患者更可能出现较高BMI、降压治疗、使用阿司匹林或他汀类药物。研究数据显示,在ARIC组,322名基线PPI使用者中发生了56例CKD(14.2/1,000人年),10160名非PPI使用者中,出现了1382例CKD(10.7 /1,000人年) 。未校正和校正后的分析均显示使用PPI与CKD风险相关。根据数据对ARIC组参与者进行10年CKD绝对风险估计,在322名PPI使用者中该值为11.8%,而非PPI使用者,该值为8.5%。已经有呼吁称减少不必要的PPI的使用。

不仅如此,近年来还发现PPIs一些潜在风险,如JAMA Neurol:质子泵抑制剂增加痴呆风险,以及 PPI的使用会增加肺部感染的风险!,这些都值得临床关注!

原始出处:

Yan Xie et al., Proton Pump Inhibitors and Risk of Incident CKD and Progression to ESRD,Journal of the American Society of Nephrology, 13 April 2016

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    2016-11-10 chenhongpeng
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    2017-01-15 jklm09
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    2016-05-12 卡莲

    值得学习

    0

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    2016-05-12 卡莲

    值得学习

    0

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    2016-05-12 卡莲

    肾脏病患者还是要慎用ppi

    0

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    2016-05-12 卡莲

    损伤机制是什么

    0

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