Acid-suppressive Drugs and Community-acquired Pneumonia
Acid-suppressive Drugs and Community-acquired Pneumonia
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DOI：
10.1097/ede.0b013e3181b5f27d
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发表时间：
2009-11-01
期刊：
影响因子：
5.4
通讯作者：
Johansson, Saga
中科院分区：
文献类型：
--
作者：
Garcia Rodriguez, Luis Alberto;Ruigomez, Ana;Johansson, Saga
背景：抑酸可能会增加社区获得性肺炎的风险。我们在英国初级保健系统中调查了这种关联，考虑到适应症造成混淆的可能性。方法：我们在健康改善网络数据库中确定了 2000 年至 2005 年间新诊断出肺炎的 20-79 岁患者 (n = 7297)。病例通过人工审查进行验证，并与年龄和性别匹配的对照进行比较（n = 9993）。使用无条件逻辑回归，我们估计了当前使用抑酸药物与不使用抑酸药物相关的肺炎相对风险 (RR)。结果：当前使用质子泵抑制剂会增加新诊断的社区获得性肺炎的发生率（RR = 1.16 [95% 置信区间 1.03-1.31]），但 H-2 受体拮抗剂则不会增加（0.98 [0.80-1.20]）。仅在质子泵抑制剂治疗的前 12 个月内，肺炎风险增加才明显。有一些剂量反应的证据。在服用质子泵抑制剂不到一年的患者中，当前使用质子泵抑制剂用于治疗消化不良或消化性溃疡（1.73 [1.29-2.34]）时，社区获得性肺炎的风险高于用于胃食管反流病或预防与阿司匹林或非甾体抗炎药相关的上消化道损伤（1.22 [0.97-1.52]）。结论：我们观察到，社区获得性肺炎的风险略有增加。社区获得性肺炎与当前质子泵抑制剂的使用有关，特别是在治疗的前 12 个月和较高剂量时。这可能部分归因于潜在的迹象。
Background: Acid suppression may increase the risk of community-acquired pneumonia. We investigated this association in the United Kingdom primary care system taking account of the potential for confounding by indication.Methods: We identified patients aged 20-79 years in The Health Improvement Network database with a new diagnosis of pneumonia between 2000 and 2005 (n = 7297). Cases were validated by manual review and compared with age- and sex-matched controls (n = 9993). Using unconditional logistic regression, we estimated the relative risk (RR) of pneumonia associated with current use of acid-suppressive drugs compared to nonuse.Results: Newly diagnosed community-acquired pneumonia was increased with current use of proton pump inhibitors (RR = 1.16 [95% confidence interval 1.03-1.31]) but not H-2-receptor antagonists (0.98 [0.80-1.20]). An increased risk of pneumonia was evident only in the first 12 months of treatment with proton pump inhibitors. There was some evidence of a dose response. Among patients taking proton pump inhibitors for less than I year, the risk of community-acquired pneumonia was stronger when current use was for dyspepsia or peptic ulcer (1.73 [1.29-2.34]) than for gastroesophageal reflux disease or prevention of upper gastrointestinal injury associated with aspirin or nonsteroidal anti-inflammatory drugs (1.22 [0.97-1.52]).Conclusions: We observed a small increase in the risk of community-acquired pneumonia associated with current proton pump inhibitor use, particularly during the first 12 months of treatment and at higher doses. This may be due in part to the underlying indication.