Use of acid-suppressive drugs and risk of pneumonia: a systematic review and meta-analysis
Use of acid-suppressive drugs and risk of pneumonia: a systematic review and meta-analysis
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DOI：
10.1503/cmaj.092129
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发表时间：
2011-02-22
影响因子：
14.6
通讯作者：
Lee, Kang-Sook
中科院分区：
文献类型：
--
作者：
Eom, Chun-Sick;Jeon, Christie Y.;Lee, Kang-Sook
背景：关于抑酸药物的使用和肺炎风险之间的关系，观察性研究和随机对照试验得出了不一致的结果。方法：我们检索了三个电子数据库(Medlin E[PubMed]、Embase和Cochrane Library)，检索时间为2009年8月28日。两名评估者独立提取了数据。由于异质性，我们使用随机效应荟萃分析来获得疗效的汇总估计。结果：我们确定了31项研究：5项病例对照研究、3项队列研究和23项随机对照试验。八项观察性研究的荟萃分析显示，使用质子泵抑制剂(调整后的优势比[OR]1.27，95%可信区间[CI]1.11-1.46，I-2 90.5%)和组胺2受体拮抗剂(调整后的OR为1.22，95%CI为1.09-1.36，I-2为0.0%)的人群患肺炎的总体风险更高。在随机对照试验中，组胺2受体拮抗剂的使用与医院获得性肺炎的风险增加相关(相对风险1.22，95%可信区间1.01-1.48，I-2 30.6%)。解释：使用质子泵抑制剂或组胺2受体拮抗剂可能与社区和医院获得性肺炎的风险增加相关。鉴于这些潜在的不良反应，临床医生在给有风险的患者开抑酸药物时应谨慎行事。
Background: Observational studies and randomized controlled trials have yielded inconsistent findings about the association between the use of acid-suppressive drugs and the risk of pneumonia. We performed a systematic review and meta-analysis to summarize this association.Methods: We searched three electronic databases (MEDLIN E [PubMed], Embase and the Cochrane Library) from inception to Aug. 28, 2009. Two evaluators independently extracted data. Because of heterogeneity, we used random-effects meta-analysis to obtain pooled estimates of effect.Results: We identified 31 studies: five case-control studies, three cohort studies and 23 randomized controlled trials. A meta-analysis of the eight observational studies showed that the overall risk of pneumonia was higher among people using proton pump inhibitors (adjusted odds ratio [OR] 1.27, 95% confidence interval [CI] 1.11-1.46, I-2 90.5%) and histamine 2 receptor antagonists (adjusted OR 1.22, 95% CI 1.09-1.36, I-2 0.0%). In the randomized controlled trials, use of histamine 2 receptor antagonists was associated with an elevated risk of hospital-acquired pneumonia (relative risk 1.22, 95% CI 1.01-1.48, I-2 30.6%).Interpretation: Use of a proton pump inhibitor or histamine 2 receptor antagonist may be associated with an increased risk of both community- and hospital-acquired pneumonia. Given these potential adverse effects, clinicians should use caution in prescribing acid-suppressive drugs for patients at risk.