质子泵抑制剂与小肠细菌过度增长关系的 Meta 分析

Use of proton pump inhibitor and risk of small intestinal bacterial overgrowth：a meta-analysis of observational studies

目的评价质子泵抑制剂（PPI）与小肠细菌过度增长之间的关系。方法检索MEDLINE ／PubMed、Cochrane Central Register of Controlled Trials、中国生物医学文献数据库等，按标准纳入 PPI 导致细菌过度增长的所有观察性研究。采用 Cochrane 协作网提供的 RevMan 5．1软件进行荟萃分析。结果8项观察性研究共576例患者纳入分析。结果显示，PPI 显著增加发生胃肠道细菌过度增长的风险（阳性率为46．61％），与对照组比较差异有统计学意义[风险比（OR）＝13．46，95％可信区间（CI）：7．00～25．88，P ＜0．01]；不同剂量 PPI 比较，20 mg／d 和40 mg／d 组细菌过度增长的阳性率分别为47．62％和39．62％；不同疗程 PPI 比较，疗程＞1个月组与对照组差异有统计学意义（OR ＝16．47％，95％CI：7．82～34．71，P ＜0．01），而疗程＜1个月组与对照组差异无统计学意义（P ＞0．05）；细菌培养组和葡萄糖氢呼气试验组，细菌过度增长的阳性率分别为48．03％和45．87％，与对照组比较差异均有统计学意义（P ＜0．01）。结论PPI 可增加胃肠道发生细菌过度增长的风险，但短期治疗可能不影响胃酸阻止细菌定殖胃肠道的功能。

Objective To assess the associations between Proton Pump inhibitor（PPI）therapy and risk of bacterial overgrowth using Meta-analysis.Methods We searched MEDLINE（PubMed）,the Cochrane Library,China Biological Medicine in December 2012.Two evaluators independently reviewed and selected articles,based on pre-determined selection criteria.Results Eight observational studies, which involved 576 participants,were included in the final analysis.The overall use of PPI was significant-ly associated with the risk of bacterial overgrowth in a fixed-effects model meta-analysis of all 8 observa-tional studies（OR =13.46,95%CI：7.00 ~25.88）.Also,in Subgroup analysis of bacterial overgrowth positivity in PPI users based on PPI dose,there was a association between PPI use of 20 mg/d or 40 mg/d and the risk of bacterial overgrowth in a fixed-effects meta-analysis（P 〈0.01）;Based on course of PPI treatment,there was no association between PPI use less than 1 month and the risk of bacterial overgrowth （P 〉0.05）,while in treatment more than 1 month,there has a significant association（OR =16.47%, 95%CI：7.82 ~34.71 ）.Based on diagnostic methods of bacterial overgrowth,there was a association between PPI use of bacterial culture or GHBT and the risk of bacterial overgrowth in a fixed-effects meta-analysis（P 〈0.01）.Conclusion PPI therapy is associated with an increased risk of bacterial over-growth,But short-term management may not affect hydrochloric acid preventing bacteria from colonisation in gastrointestine.