氫離子幫浦抑制劑與氣喘患者之關聯性

The association between proton pump inhibitors and asthma patients

王耀東(Yao-Tung Wang)

指導教授 ： 魏正宗

中山醫學大學/醫學院/醫學研究所/博士(2022年)

https://doi.org/10.6834/csmu202200034

摘要

研究目的：胃食道逆流疾病是國人最常見的消化道疾病之一，也是會引起慢性咳嗽和氣喘的重要原因，而氫離子幫浦抑制劑是目前制酸劑中最強的藥物，我們希望評估使用氫離子幫浦抑制劑的患者，改善胃食道逆流疾病的症狀後，是否能減少氣喘的發生率。
研究方法：我們使用 1999年至 2013年台灣「全民健康保險資料庫」 (National Health Insurance Research Database) 的數據，進行一項以全國民眾為對象的回溯性世代研究法。我們以年齡、性別、合併症（包含高血壓、高脂血症、胃食道逆流疾病、過敏性鼻炎、異位性皮膚炎、消化性潰瘍、糖尿病和睡眠呼吸中止症）和藥物（組織胺阻斷劑、非類固醇消炎止痛藥和乙醯酚胺）等，按 1：1 的比例匹配，選擇了 24,077例使用氫離子幫浦抑制劑超過 3個月的成年受試者為治療組，和 24,077例未用過氫離子幫浦抑制劑的對照組。我們使用存活分析統計來評估試驗期間，治療組與對照組的累積氣喘發生率與差異，並利用迴歸分析來計算調整後的風險比率。
研究結果：使用氫離子幫浦抑制劑的試驗組中，氣喘的總體發病率，是對照組的 1.58倍，調整後的風險比率是 1.76。在過去無消化性潰瘍疾病的患者中，曾使用氫離子幫浦抑制劑相關的氣喘疾病發生率，調整後的風險比率高於非氫離子幫浦抑制劑組（1.95；95% CI，1.80–2.11）。在未使用過組織胺阻斷劑 (1.81; 95% CI, 1.66-1.96)、非類固醇消炎止痛藥 (1.93; 95% CI, 1.73-2.15) 和乙醯酚胺 (1.88; 95% CI, 1.70–2.08)) 的患者中，對於使用氫離子幫浦抑制劑導致的氣喘風險也更顯著。
結論：根據我們的研究，無論年齡、性別、合併症和曾使用過何種藥物，長期使用氫離子幫浦抑制劑的患者，有較高後續發生氣喘疾病的風險。

關鍵字

氫離子幫浦抑制劑 ； 氣喘 ； 組織胺阻斷劑 ； 胃食道逆流疾病 ； 全民健康保險資料庫

並列摘要

Background: The relationship between proton pump inhibitors (PPIs) and asthma is controversial. The goal of this study was to determine the association between PPI use in non-asthma subjects and their subsequent asthma prevalence.
Methods: We conducted a nationwide, population-based retrospective cohort study using data from the National Health Insurance Research Database (NHIRD) of Taiwan from 1999 to 2013. We identified 24,077 adult patients with PPI use for more than 3 months and 24,077 controls matched by propensity score on a one-to-one ratio for age, gender, comorbidities (hypertension, hyperlipidemia, gastroesophageal reflux disease, allergic rhinitis, atopic dermatitis, peptic ulcer disease, diabetes, and sleep apnea syndrome), and medications (histamine 2 receptor antagonists [H2RA], nonsteroidal anti-inflammatory drugs [NSAIDs], and acetaminophen). The cumulative asthma incidence for the two cohorts in the follow-up period was estimated with the Kaplan–Meier method, and the difference was examined using the log-rank test. Multivariate Cox regression models were used to calculate the adjusted hazard ratios (HR).
Results: The overall incidence of asthma was 1.58-fold greater in the PPI cohort than in the non-PPI cohort (13.3 versus 8.4 per 1,000 person-years), with an adjusted HR of 1.76 (95% confidence interval [CI], 1.64–1.88). In patients without previous peptic ulcer disease, the adjusted HR of asthma associated with PPIs was higher than in the non-PPI group (1.95; 95% CI, 1.80–2.11). The risk of asthma due to PPI use was also more significant in patients not receiving H2RA (1.81; 95% CI, 1.66–1.96), NSAIDs (1.93; 95% CI, 1.73–2.15), and acetaminophen (1.88; 95% CI, 1.70–2.08).
Conclusions: This population base study demonstrated that patients with long-duration of PPI use are at a higher risk of developing asthma, regardless of age, gender, comorbidities, and medications.

並列關鍵字

proton pump inhibitors ； asthma ； histamine 2 receptor antagonists ； gastroesophageal reflux disease ； National Health Insurance Research Database

參考文獻

Uncategorized References

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