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Proton pump inhibitors use and risk of developing spontaneous bacterial peritonitis in cirrhotic patients: A systematic review and meta-analysis
Gut Pathogens ( IF 4.3 ) Pub Date : 2021-03-19 , DOI: 10.1186/s13099-021-00414-8
Saad Alhumaid , Abbas Al Mutair , Zainab Al Alawi , Abdul Rehman Zia Zaidi , Ali A. Rabaan , Alyaa Elhazmi , Awad Al-Omari

Spontaneous bacterial peritonitis (SBP) is one of the most common infectious diseases in patients with cirrhosis and is associated with serious prognosis. A prevailing dogma posits that SBP is exacerbated by the frequent use of proton pump inhibitors (PPIs). To re-assess the association between PPIs use and SBP incidence with larger and better-quality data. The studies were identified by searching Proquest, Medline, and Embase for English language articles published between January 2008 and March 2020 using the following keywords alone or in combination: anti-ulcer agent, antacid, proton pump inhibitor, proton pumps, PPI, omeprazole, rabeprazole, lansoprazole, pantoprazole, esomeprazole, peritonitis, spontaneous bacterial peritonitis, SBP, ascites, cirrhosis, ascitic and cirrhotic. Three authors critically reviewed all of the studies retrieved and selected those judged to be the most relevant. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement was followed. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated. Sub-group analyses were done to decrease the heterogeneity. A total of twenty-three studies: seven case–control, and sixteen cohorts, involving 10,386 patients were analyzed. The overall results showed a statistically significant association between SBP and PPIs use (pooled odds ratio (OR): 1.80, 95% CI of 1.41 to 2.31). Substantial heterogeneity was observed. On subgroup analysis involving cohort studies, the association was weaker (OR: 1.55 with 95% CI of 1.16 to 2.06 p < 0.00001) but still statistically significant and with high heterogeneity (Chi2p = 57.68; I2 = 74%). For case–control studies, the OR was 2.62 with a 95% CI of 1.94 to 3.54. The funnel plot was asymmetric and Egger’s test confirmed asymmetry suggesting publication bias (intercept = − 0.05, SE = 0.27, P = 0.850 two-tailed). This meta-analysis sheds light on the conflicting results raised by previous studies regarding the association of SBP with PPIs use. Our meta-analysis showed that there is a weak association, although statistically significant, between SBP and PPIs use. However, the magnitude of the possible association diminished when analysis focused on higher quality data that were more robust. Thus, this updated meta-analysis suggests judicious use of PPIs among cirrhotic patients with ascites.

中文翻译:

质子泵抑制剂在肝硬化患者中的使用和发生自发性细菌性腹膜炎的风险:系统评价和荟萃分析

自发性细菌性腹膜炎(SBP)是肝硬化患者中最常见的传染病之一,并与严重的预后相关。普遍的教条认为,频繁使用质子泵抑制剂(PPI)会使SBP恶化。为了重新评估PPI的使用与SBP发生率之间的关联,并使用更大,质量更好的数据。通过在Proquest,Medline和Embase中搜索2008年1月至2020年3月之间发布的英语文章来识别研究,这些关键词单独或组合使用以下关键词:抗溃疡剂,抗酸剂,质子泵抑制剂,质子泵,PPI,奥美拉唑,雷贝拉唑,兰索拉唑,pan托拉唑,埃索美拉唑,腹膜炎,自发性细菌性腹膜炎,SBP,腹水,肝硬化,腹水和肝硬化。三位作者严格审查了所有检索到的研究,并选择了那些被认为最相关的研究。遵循了系统评价和荟萃分析(PRISMA)声明的首选报告项目。计算具有95%置信区间(CI)的合并比值比(OR)。进行了亚组分析以减少异质性。总共进行了23项研究:7例病例对照研究和16项队列研究,涉及10386名患者。总体结果显示,使用SBP和PPI之间存在统计学上的显着关联(合并赔率比(OR):1.80,95%CI为1.41至2.31)。观察到大量异质性。在涉及队列研究的亚组分析中,相关性较弱(OR:1.55,95%CI为1.16至2.06 p <0.00001),但仍具有统计学意义,且异质性较高(Chi2p = 57)。68; I2 = 74%)。对于病例对照研究,OR为2.62,95%CI为1.94至3.54。漏斗图是不对称的,Egger的检验证实了不对称,表明存在出版偏倚(截距=-0.05,SE = 0.27,P = 0.850两尾)。这项荟萃分析揭示了先前有关SBP与PPI使用之间关系的研究得出的相互矛盾的结果。我们的荟萃分析显示,SBP和PPI使用之间存在弱关联,尽管在统计学上显着。但是,当分析的重点放在质量更高,更可靠的数据上时,可能的关联程度就会降低。因此,这项最新的荟萃分析表明,肝硬化腹水患者应明智地使用PPI。漏斗图是不对称的,Egger的检验证实了不对称,表明存在出版偏倚(截距=-0.05,SE = 0.27,P = 0.850两尾)。这项荟萃分析揭示了先前有关SBP与PPI使用之间关系的研究得出的相互矛盾的结果。我们的荟萃分析显示,SBP和PPI使用之间存在弱关联,尽管在统计学上显着。但是,当分析的重点放在质量更高,更可靠的数据上时,可能的关联程度就会降低。因此,这项最新的荟萃分析表明,肝硬化腹水患者应明智地使用PPI。漏斗图是不对称的,Egger的检验证实了不对称,表明存在出版偏倚(截距=-0.05,SE = 0.27,P = 0.850两尾)。这项荟萃分析揭示了先前有关SBP与PPI使用之间关系的研究得出的相互矛盾的结果。我们的荟萃分析显示,SBP和PPI使用之间存在弱关联,尽管在统计学上显着。但是,当分析的重点放在质量更高,更可靠的数据上时,可能的关联程度就会降低。因此,这项最新的荟萃分析表明,肝硬化腹水患者应明智地使用PPI。这项荟萃分析揭示了先前有关SBP与PPI使用之间关系的研究得出的相互矛盾的结果。我们的荟萃分析显示,SBP和PPI使用之间存在弱关联,尽管在统计学上很显着。但是,当分析的重点放在质量更高,更可靠的数据上时,可能的关联程度就会降低。因此,这项最新的荟萃分析表明,肝硬化腹水患者应明智地使用PPI。这项荟萃分析揭示了先前有关SBP与PPI使用之间关系的研究得出的相互矛盾的结果。我们的荟萃分析显示,SBP和PPI使用之间存在弱关联,尽管在统计学上显着。但是,当分析的重点放在质量更高,更可靠的数据上时,可能的关联程度就会降低。因此,这项最新的荟萃分析表明,肝硬化腹水患者应明智地使用PPI。
更新日期:2021-03-19
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