Proton pump inhibitors therapy and risk of Clostridium difficile infection: Systematic review and meta-analysis.
Proton pump inhibitors therapy and risk of Clostridium difficile infection: Systematic review and meta-analysis.
复制标题
DOI：
10.3748/wjg.v23.i35.6500
复制
发表时间：
2017-09-21
影响因子：
4.3
通讯作者：
Boiculese L
中科院分区：
文献类型：
--
作者：
Trifan A;Stanciu C;Girleanu I;Stoica OC;Singeap AM;Maxim R;Chiriac SA;Ciobica A;Boiculese L
对质子泵抑制剂（PPI）治疗和艰难梭菌感染（CDI）风险进行系统综述和荟萃分析。我们对MEDLINE/PubMed和其他7个数据库进行了系统检索，检索时间为1990年1月至2017年3月，以评估PPI与CDI之间相关性的已发表研究。纳入了成人病例对照和队列研究，这些研究提供了PPI治疗与CDI发生之间相关性的信息。使用随机效应计算合并比值比（OR）估计值和95%置信区间（CI）。用I2检验和Cochran’s Q统计量评估异质性。通过漏斗图评估潜在的发表偏倚，并通过Newcastle-Occupy质量评估量表（NOS）评估研究质量。共纳入五十六项研究（40项病例对照研究和16项队列研究），共356683例患者，符合纳入标准并进行了分析。总体汇总估计值和亚组分析均显示CDI风险增加，尽管研究之间存在显著的统计学异质性。所有研究的荟萃分析显示，与非PPI使用者相比，PPI使用者与CDI风险显著相关（合并OR = 1.99，CI：1.73-2.30，P < 0.001）。在亚组分析中，这种关联仍然显著：通过设计-病例-对照（OR = 2.00，CI：1.68-2.38，P < 0.0001），队列（OR = 1.98，CI：1.51-2.59，P < 0.0001）;校正后（OR = 1.95，CI：1.67-2.27，P < 0.0001）和未校正（OR = 2.02，CI：1.41-2.91，P < 0.0001）;单中心OR = 2.18，CI：1.72-2.75，P < 0.0001年龄≥ 65岁（OR = 1.93，CI：1.40 -2.68，P <0.0001）和< 65岁（OR = 2.06，CI：1.11-3.81，P < 0.01）。亚组分析（异质性检验）中未发现显著差异：病例对照组与队列组P = 0.93，校正组与未校正组P = 0.85，单中心组与多中心组P = 0.24，年龄≥ 65岁和< 65岁组P = 0.86。研究间存在显著异质性（I2 = 85.4%，P < 0.001）以及发表偏倚的证据（漏斗图不对称检验，P = 0.002）。这项荟萃分析提供了进一步的证据，证明PPI的使用与CDI发生风险增加相关。需要进一步的高质量前瞻性研究来评估这种关联是否是因果关系。
To perform a systematic review and meta-analysis on proton pump inhibitors (PPIs) therapy and the risk of Clostridium difficile infection (CDI). METHODS We conducted a systematic search of MEDLINE/PubMed and seven other databases through January 1990 to March 2017 for published studies that evaluated the association between PPIs and CDI. Adult case-control and cohort studies providing information on the association between PPI therapy and the development of CDI were included. Pooled odds ratios (ORs) estimates with 95% confidence intervals (CIs) were calculated using the random effect. Heterogeneity was assessed by I2 test and Cochran’s Q statistic. Potential publication bias was evaluated via funnel plot, and quality of studies by the Newcastle-Otawa Quality Assessment Scale (NOS). Fifty-six studies (40 case-control and 16 cohort) involving 356683 patients met the inclusion criteria and were analyzed. Both the overall pooled estimates and subgroup analyses showed increased risk for CDI despite substantial statistical heterogeneity among studies. Meta-analysis of all studies combined showed a significant association between PPI users and the risk of CDI (pooled OR = 1.99, CI: 1.73-2.30, P < 0.001) as compared with non-users. The association remained significant in subgroup analyses: by design-case-control (OR = 2.00, CI: 1.68-2.38, P < 0.0001), and cohort (OR = 1.98, CI: 1.51-2.59, P < 0.0001); adjusted (OR = 1.95, CI: 1.67-2.27, P < 0.0001) and unadjusted (OR = 2.02, CI: 1.41-2.91, P < 0.0001); unicenter (OR = 2.18, CI: 1.72-2.75, P < 0.0001) and multicenter (OR = 1.82, CI: 1.51-2.19, P < 0.0001); age ≥ 65 years (OR = 1.93, CI: 1.40-2.68, P < 0.0001) and < 65 years (OR = 2.06, CI: 1.11-3.81, P < 0.01). No significant differences were found in subgroup analyses (test for heterogeneity): P = 0.93 for case-control vs cohort, P = 0.85 for adjusted vs unadjusted, P = 0.24 for unicenter vs multicenter, P = 0.86 for age ≥ 65 years and < 65 years. There was significant heterogeneity across studies (I2 = 85.4%, P < 0.001) as well as evidence of publication bias (funnel plot asymmetry test, P = 0.002). This meta-analysis provides further evidence that PPI use is associated with an increased risk for development of CDI. Further high-quality, prospective studies are needed to assess whether this association is causal.
登录
查看更多内容
影响因子：
6.9
作者：
Cunningham, R;Dale, B;Gaunt, N
通讯作者：
Gaunt, N
影响因子：
9.8
作者：
Aseeri, Mohammed;Schroeder, Todd;Zackula, Rosalee
通讯作者：
Zackula, Rosalee
影响因子：
7.6
作者：
Attwood, S. E.;Ell, C.;Lundell, L.
通讯作者：
Lundell, L.
影响因子：
29.4
作者：
Arora, Shifali;Dellon, Evan S
通讯作者：
Dellon, Evan S
影响因子：
6.9
作者：
Campbell, K. A.;Phillips, M. S.;Mehta, S. A.
通讯作者：
Mehta, S. A.