质子泵抑制剂对老年人肠屏障功能的影响

Effects of proton pump inhibitors on intestinal barrier function in the elderly

目的探讨常规剂量的质子泵抑制剂（PPI）对老年人肠黏膜屏障功能的影响。方法回顾性分析2016年4—12月我科收治的老年胃酸相关性疾病患者，患者均有胃镜检查明确诊断，PPI的治疗时间为1～6个月，检测治疗前后患者的肝功能、C反应蛋白、降钙素原、二胺氧化酶（DA0）、D-乳酸以及血清内毒素水平。结果符合标准的88例患者，年龄80～96岁，在完成1个月治疗后，大部分患者的消化道症状有明显改善，患者在治疗前后肝功能指标丙氨酸氨基转氨酶（ALT）和天门冬氨酸氨基转移酶（AST），以及血清C反应蛋白（CRP）、降钙素原（PCT）等指标基本在正常范围内。88例患者治疗后DAO、D-乳酸以及血清内毒素水平分别为（6．53±3．00）U／L、（7．31±3．67）mg／L、（11．69±5．98）U／L，与治疗前各指标（6．23±2．42）U／L、（7．62±3．35）mg／L、（10．97±5．76）U／L比较，差异无统计学意义（t=-0．91、0．73、-1．66，P=0．37、0．47、0．10）；其中23例患者因病情需要继续PPI治疗6个月，复查该组患者的血清DAO、D-乳酸以及血清内毒素水平分别为（5．35±2．49）U／L、（8．12±3．84）mg／L、（10．23±5．51）U／L，与治疗前各指标（6．59±2．69）U／L、（7．71±3．65）mg／L、（10．41±6．45）U／L比较，差异无统计学意义（t=1．89、-0．73、0．18，P=0．07、0．47、0．86）。结论口服常规剂量PPI制剂不超过6个月，对老年人肠道机械屏障功能无明显影响，但PPI对老年人肠道菌群的作用仍需要进一步深入研究。

Objective To explore the effects of regular doses of proton pump inhibitors （PPIs） on intestinal barrier function in the elderly. Methods The elderly hospitalized patients with acid- related disorders were retrospectively analyzed from April to December 2016 in Department of Geriatrics,the General Hospital of Guangzhou Military Command. Based on the criteria of inclusion and exclusion,all patients received the stomachoscopy examination, and received PPI orally for more than 1 month. The treatment continued for 1-6 months. The blood status was routinely examined at pre-and post-treatment, including the level of liver function,C reactive protein （CPR）, procalcitonin （PCT） ,diamine oxidase （DAO） ,D-lactate acid and serum endotoxin. Results A total of 88 elderly patients aged 80-96 years were involved. Most patients took PPI for 1 month. The levels of alanine aminotransferase,aspartate amino transferase, CPR and PCT were mostly normal after 1 month of treatment. Meanwhile, there were the comparabilities between the post-and pre-treatment groups in levels of DAO（（6.53±3.00） vs. （6.23±2.42） U/L; t= -0.91, P=0. 37] ,of D-lactate acid[（7.31± 3.67） vs. （7.62±3.35） mg/L; t=0.73,P=0.47]and of serum endotoxin[（11. 69±5.98） vs （10.97 ± 5.76） U/L ; t= - 1.66, P= 0.10] without statistical significance. Additionally, after 23 patients took PPI for 6 months,there were no statistical significances between the pre-and post-treatment groups in the levels of DAO[（5.35±2.49）vs. （6.59±2.69） U/L, t=1. 89, P=0.07] ,of D-lactate acid[（8.12± 3.84） vs. （7.71± 3.65） mg/L, t= -0.73, P= 0.47] and of serum endotoxin[（ 10.23 ± 5.51） vs. （10.41±6.45） U/L, t=0.18, P=0.86]. Conclusions There is no significant effect on intestinal permeability and intestinal mucosa barrier function in the elderly taking PPI for 6 months. New studies are needed to understand the role of PPI in the intestinal microflora in the elderly.