PPIs与重症缺血性脑卒中患者短期、长期死亡风险的关联:基于MIMIC-Ⅲ数据库的回顾性队列研究  

Association of PPIs use with short-term and long-term mortality risk in patients with severe ischemic stroke: a retrospective cohort study based on the MIMIC-Ⅲ database

作　　者：覃偲偲 张慧涛[1] 潘海燕[1] 朱瑶丽[1] 曾利 QIN Sisi;ZHANG Huitao;PAN Haiyan;ZHU Yaoli;ZENG Li(Department of Critical Care Medicine,the Fifth Affiliated Hospital of Sun Yat-Sen University,Zhuhai 519000,Guangdong Province,China;Department of Neurology,the Second Affiliated Hospital of Guizhou University of Chinese Medicine,Guiyang 550003,China)

机构地区：[1]中山大学附属第五医院重症医学科,广东珠海519000 [2]贵州中医药大学第二附属医院神经内科,贵阳550003

出　　处：《药物流行病学杂志》2024年第1期45-51,共7页Chinese Journal of Pharmacoepidemiology

摘　　要：目的 研究质子泵抑制剂(PPIs)的使用与重症缺血性脑卒中患者短期、长期死亡风险的关联。方法 基于美国重症监护医学信息数据库Ⅲ(MIMIC-Ⅲ),纳入年龄≥18岁、首次入住重症监护病房(ICU)并诊断为缺血性脑卒中的患者。根据住院期间是否使用过PPIs(泮托拉唑、兰索拉唑和奥美拉唑),将患者分为PPIs组和非PPIs组。对比2组基线数据后,采用Kaplan-Meier生存曲线和Cox比例风险回归模型分析使用PPIs与重症缺血性脑卒中患者ICU死亡风险、30 d死亡风险、90 d死亡风险的关联。结果 共纳入1 015例患者,其中PPIs组402例,非PPIs组613例。基线资料显示,重症缺血性脑卒中患者的ICU死亡率、30 d死亡率、90 d死亡率分别为15.37%,13.60%,20.10%。Kaplan-Meier生存曲线表明,相对于非PPIs组,PPIs组的ICU死亡风险较低(P=0.002)。Cox比例风险回归模型在调整多个变量后的结果显示,PPIs组相对于非PPIs组的ICU死亡风险比为0.671 9 [95%CI(0.478 8,0.942 8),P=0.021],但2组患者30 d和90 d的死亡风险差异均无统计学意义(P> 0.05)。结论 重症缺血性脑卒中患者中,使用PPIs可能会有效降低患者的ICU死亡风险,但对患者的30 d死亡风险和90 d死亡风险没有改善作用。Objective To investigate the association of proton pump inhibitors(PPIs)use with short-term and long-term mortality risk in patients with severe ischemic stroke.Methods This retrospective study based on the U.S.Medical Information Mark for Intensive CareⅢ(MIMIC-Ⅲ)database,ICU patients aged≥18 years with the first ICU admission and a diagnosis of ischemic stroke were finally included in the study.All enrolled subjects were divided into PPIs group and non-PPIs group according to whether they had used PPIs(pantoprazole,lansoprazole and omeprazole)during hospitalization.Kaplan-Meier survival analyses and Cox regression models were used to analyze the association between the use of PPIs and the risk of ICU death,30 d risk of death,90 d risk of death in patients with severe ischemic stroke.Results A total of 1015 patients were included,402 cases in the PPIs group and 613 in the non-PPIs group.The ICU-mortality,30 d and 90 d mortality were 15.37%,13.60%and 20.10%,respectively.Kaplan-Meier survival analyses illustrated that the PPIs group survived better than non-PPIs group in ICU mortality analysis(P=0.002).In Cox regression analysis,after adjustment for potential confounders,the hazard ratio(HR)for ICU mortality in the PPIs group relative to the non-PPIs group was 0.6719(95%CI 0.4788 to 0.9428,P=0.021),but there was no significant difference between 30 d and 90 d mortality(P>0.05).Conclusion In patients with severe ischemic stroke,the use of PPIs may be effective in reducing the risk of ICU death,but does not improve 30 d and 90 d risk of death in patients.

关 键 词：质子泵抑制剂 重症缺血性脑卒中 死亡风险 美国重症监护医学信息数据库Ⅲ 

分 类 号：R743.3[医药卫生—神经病学与精神病学]