质子泵抑制剂与肝硬化患者发生自发性细菌性腹膜炎风险关系的meta分析

The relationship between proton pump inhibitor and the risk of spontaneous bacterial peritonitis in cirrhotic patients: a meta-analysis

目的系统评价肝硬化患者使用质子泵抑制剂(PPI)与发生自发性细菌性腹膜炎(SBP)风险的关系。方法检索有关数据库截至2019年2月收录的文献,收集以PPI与肝硬化患者发生SBP关系为主题、主要结局指标为SBP发生率、经纽卡斯尔-渥太华量表或改良Jadad评分法评定为高质量的病例对照研究、队列研究和RCT,采用RevMan5.3软件进行meta分析。结果共18篇文献纳入分析。18项研究中,病例对照研究8项,队列研究9项,RCT1项;前瞻性研究6项,回顾性研究12项;单中心研究13项,多中心研究5项;共包括6961例患者,试验组3353例,对照组3608例。试验组患者使用PPI,对照组未接受任何抑酸药物治疗。18项研究的总体分析结果显示,试验组SBP发生风险明显高于对照组(OR=1.83,95%CI:1.43~2.33,P<0.001)。对8项病例对照研究的亚组分析结果显示,试验组SBP发生风险明显高于对照组(OR=2.38,95%CI:1.69~3.36,P<0.001);对9项队列研究的亚组分析结果显示,试验组SBP发生风险明显高于对照组(OR=1.27,95%CI:1.04~1.55,P=0.020);对12项回顾性研究的亚组分析结果显示,试验组SBP发生风险明显高于对照组(OR=1.81,95%CI:1.34~2.45,P=0.001);对6项前瞻性研究的亚组分析结果显示,试验组SBP发生风险明显高于对照组(OR=1.88,95%CI:1.27~2.79,P=0.002);对13项单中心研究的亚组分析结果显示,试验组SBP发生风险明显高于对照组(OR=1.97,95%CI:1.41~2.76,P<0.001);对5项多中心研究的亚组分析结果显示,试验组SBP发生风险明显高于对照组(OR=1.69,95%CI:1.33~2.13,P<0.001)。结论肝硬化患者使用PPI可增加发生SBP的风险。建议对肝硬化患者慎用PPI。

Objective To evaluate the relationship between proton pump inhibitor (PPI) and the risk of spontaneous bacterial peritonitis (SBP) in cirrhosis patients systematically. Methods The literature on the related databases as of February 2019 was searched. Case-control studies, cohort studies, and randomized controlled studies (RCT), which set the theme as the relationship between PPI and SBP in cirrhosis patients, whose main outcome indicator was SBP incidence, and which had high quality assessed by Newcastle-Ottawa Scale or modified Jadad scoring method, were collected. The meta-analysis was performed using Rev Man 5.3 software. Results A total of 18 studies were enrolled in the meta-analysis. Of the 18 studies, 8 were case-control studies, 9 were cohort studies, and 1 was RCT;6 were prospective studies and 12 were retrospective studies;13 were single-center studies and 5 were multi-center studies. A total of 6 961 patients were included, 3 353 in the trial group and 3 608 in the control group. The patients in the trial group received PPI alone and the patients in the control group did not receive any acid-suppressing drug. Overall analysis of the 18 studies showed that the risk of SBP in patients in the trial group was markedly higher than that in the control group (OR=1.83, 95%CI: 1.43-2.33, P<0.001). The results of subgroup analysis for 8 case-control studies showed that the risk of SBP in patients in the trial group was markedly higher than that in the control group(OR=2.38, 95%CI: 1.69-3.36, P<0.001). The results of subgroup analysis for 9 cohort studies showed that the risk of SBP of patients in the trial group was markedly higher than that in the control group (OR=1.27, 95%CI: 1.04-1.55, P=0.020). The results of subgroup analysis for 12 retrospective studies showed that the risk of SBP in patients in the trial group was markedly higher than that in the control group (OR=1.81, 95%CI: 1.34-2.45, P=0.001). The results of subgroup analysis for 6 perspective studies showed that the risk of SBP in patients in the trial group was markedly higher than that in the control group (OR=1.88, 95%CI: 1.27-2.79, P=0.002). The results of subgroup analysis for 13 single-center studies showed that the risk of SBP in patients in the trial group was markedly higher than that in the control group (OR=1.97, 95%CI: 1.41-2.76, P<0.001). The results of subgroup analysis for 5 multicenter studies showed that the risk of SBP in patients in the trial group was markedly higher than that in the control group (OR=1.69, 95%CI: 1.33-2.13, P<0.001). Conclusions PPI can increase the risk of SBP in patients with liver cirrhosis. It is suggested that PPI be used cautiously in patients with liver cirrhosis.