胃溃疡患者应用质子泵抑制剂的远期风险研究

The risks of long-term proton pump inhibitors on gastric ulcer patients

[目的]探究胃溃疡患者长期应用质子泵抑制剂（PPI）可能导致的风险。[方法]选取我院2012年3月~2014年9月在我院消化科门诊就诊的长期服用（〉3年）PPI的108例胃溃疡患者作为研究组,选取无服用PPI或抑酸剂史的健康志愿者108人作为对照组,记录两组对象的临床资料,检测血红蛋白、血营养元素包括血清维生素B12,叶酸,血清镁、铁、钙、锌等元素的含量、血清胃泌素的浓度,比较两组对象髋关节及腰椎的骨密度和计算T值并进行葡萄糖氢呼气试验（GHBT）判断小肠细菌过生长情况（SIBO）。[结果]研究组血清镁浓度[（1.05±0.09）mmol/L]明显高于对照组[（0.94±0.07）mmol/L],其差异具有统计学意义（t=4.526,P〈0.01）,其他营养元素及血红蛋白差异均无统计学意义（P〉0.05）,研究组血清胃泌素水平[（109.32±26.61）ng/L]高于对照组的水平[（75.28±24.73）ng/L,t=6.017,P〈0.01];研究组髋关节总体和髋关节粗隆间部位T值均低于对照组[（-0.89±0.98）比（-0.41±1.07）,t=-2.532,P〈0.05、（-0.58±0.89）比（-0.17±1.01）,t=-2.273,P〈0.05];两组腰椎总T值的均值差异无统计学意义（P〉0.05）;研究组（48例/108例,44.44%）中发生SIBO的患者显著多于对照组（4例/108例,3.70%）,差异有统计学意义（χ2=19.507,P〈0.01）。[结论]长期服用PPI的胃溃疡患者可引起血清镁浓度和血清胃泌素升高和髋骨骨密度下降,有引发骨质疏松的可能。

[Objective]To explore the risks of long-term proton pump inhibitors（PPI）on gastric ulcer pa- tients. [Methods]A total of 108 gastric ulcer patients who took long-term PPI were selected from outpatient of gastroenterology at our Hospital during March 2012 to September 2014 and 108 healthy volunteers with- out using PPI and antacid were selected as control group. Long-term PPI use was defined as taking PPI for at least three years, clinical data, concentration of serum hemochrome, vitamin B12, colic acid, serum magne- sium,iron,calcium, zinc, serum gastrin, bone density of hip joint and lumbar vertebra were compared be- tween two groups and evaluate the SIBO with GHBT. [Results] Higher serum Mg compared to control group[（1.05±0.09）mmol/L VS（0.94±0.07）mmol/L,t=4. 526,P=0. 000）. No difference of other nutri- tion elements and Hb between study and control groups（P〉0.05）. The serum gastrin of study group was significant higher than control group[（109.32 ± 26.61） ng/L VS （75.28 ± 24.73） rig/L, t = 6. 017, P = 0. 000]. T value of total bone density of hip and inter-hip both were lower than those in control group [（-0.89±0.98）VS（-0. 41±1.07）,t=-2.532,P=0.012 and（ 0.58±0.89）VS（-0.17±1. 01）,t=-2. 273,P=0. 028]. No statistical differences existed in T value of neck of hip,as well as total T value of lumbar between study and control groups（P〉0.05）. The study group is more likely to suffer SIBO than control group[（48/108,44.44%）VS（4/108,3.70%）,x^2=19. 507,P=0. 000）. [Conclusion]Long-term use of PPI decrease hip density and increase concentration of serum gastrin and Mg and may lead to osteoporosis.