质子泵抑制剂对髋部骨折影响的Meta分析  

Proton pump inhibitors and risk of hip fracture： a systematic review

作　　者：张颖[1] 于晓峰[1] 张赣生[1] 郭正扬 张自妍[1] 赵尚敏[1] 

机构地区：[1]复旦大学附属华东医院消化科,上海200040

出　　处：《中华全科医师杂志》2015年第3期212-217,共6页Chinese Journal of General Practitioners

摘　　要：目的评价质子泵抑制剂（PPIs）对髋部骨折风险的影响。方法通过计算机检索Medline、Embase、Cochrane图书馆、CBM等数据库，纳入PPIs与髋部骨折风险的临床研究进行Meta分析，同时对PPIs服用时间、剂量、糖皮质激素服用情况以及骨质疏松等因素进行亚组分析。用Stata软件进行统计分析。结果共纳入11篇文献，累计纳入研究对象1107577例，平均年龄≥60岁，其中包括PPls服用者298612例，髋部骨折85828例。Meta分析结果显示，正在服用PPIs的患者发生髋部骨折的风险较非PPIs服用者增加46％（OR=1．47，95％CI：1．26～1．70，P=0．000）。接受PPIs治疗的最初1年和1～3年内髋部骨折的风险随服药时间的延长而呈趋势性增加（OR值分别为1．18和1．23，P〈0．05），维持治疗超过6年以上者骨折风险增加更为显著（OR=1．38，95％CI：1．27～1．50，P=0．000）。没有发现PPIs与髋部骨折风险剂量一效应关系的一致性趋势变化。同时服用糖皮质激素和PPIs可使髋部骨折的风险显著增加。骨质疏松患者服用PPIs治疗后髋部骨折的发生率与非PPIs服用者相比差异并无统计学意义（P〉0．05）。结论PPIs治疗会在一定程度上增加髋部骨折的危险，尤其是老年人群，临床医师应意识到该类药物的潜在风险，适度医疗，合理选择，避免不良反应的发生．Objective To explore the effects of using proton pump inhibitors （PPIs） on the outcomes of hip fracture. Methods Searches were conducted through Medline, Embase, Coehrane Library and Chinese Biomedical Literature Database to identify the studies of the association between PPIs exposure and hip fi＇acture. Quality of studies was assessed using the Newcastle-Ottawa Quality Assessment Scale. Pooled odds ratios （ORs） and 95% confidence interval （Cls） were calculated for the risk of hip fracture associated with current exposure of＇ PPIs. And several subgroups were analyzed by dosing duration, dose, osteoporosis and cortieosteroid usage to explore potential study heterogeneities. All statistical analyses were performed with STATA software. Results Among 11 publications included for final analysis, there were a total of 1 107 577 subjects with an average age of over 60 years. A positive relationship existed between PPIs exposure and hip fracture with an OR of 1.46 （95% CI： 1.26 - 1.70, P =0. 000） as compared with non- PPl-users, especially those on concurrent corticosteroid and PPIs. A significantly increased risk of hip fracture was fimnd in the group of a short-term duration for under 1 year （ OR = 1.18, 95% CI： 1.01 - 1.38, P=0.041）, medium-term for 1 -3 years （OR =1.23, 95%CI： 1.01 - 1.49, P=0.038） and longer duration fl）r over 6 years （ OR = 1.38, 95% CI： 1.27 - 1.50, P =0. 000）. Furthernmre, concurrent use of PPIs was not associated with an increased risk of hip fracture in a definite dose-response manner. As compared with non-PPI-users, no significantly increased risk of hip fracture was found in PPI-users with osteopnrnsis （ P 〉 0. 05 ）. Publication bias was not present. Conclusions Use of PPIs may be somewhat associated with an incxeased risk of hip fi＇acture. Considering potential adverse effects, clinicians should prescribe cautiously PPIs for high-risk patients, especially elders.

关 键 词：骨折 髋 质子泵抑制剂 META分析 

分 类 号：R683[医药卫生—骨科学]