JAMA Pediatrics:质子泵抑制剂或可增加儿童骨折风险

2020-07-21 Fu Yuang MedSci原创

质子泵抑制剂(PPIs)是儿童胃酸相关疾病的主要治疗药物。此前PPIs已被证实与成人骨折风险增加有关,但其对于儿童骨折风险的影响尚未被证实。

     质子泵抑制剂(PPIs)是儿童胃酸相关疾病(gastric acid–associated disorders)的主要治疗药物。据报道,近年来儿童使用PPI的数量增加了3-4倍,但医师们依然对这些药物应用于低龄患者的安全性存在担忧。因此,明确PPIs对儿童的安全性是至关重要的。此前PPIs已被证实与成人骨折风险增加有关,但其对于儿童骨折风险的影响尚未被证实。骨折是儿童群体常见的疾病,幼年时期的骨折病史会增加以后发生骨折的风险。PPIs的胃酸抑制作用会导致钙吸收和骨代谢障碍进而引起骨折。近日,来自瑞典Karolinska大学的研究团队在《JAMA Pediatrics》上发表了一篇在全瑞典范围内开展的一项队列研究,旨在探索PPIs的使用与小儿骨折风险之间 的联系。

     这项队列研究的时间跨度为自2006年7月至2016年12月。研究对象数据来源于各医院门诊登记患者和住院患者的相关信息,该研究的纳入标准为年龄小于18岁的患儿,根据倾向性得分和年龄划分为使用PPIs组与未使用PPI组,总计纳入115933对患者进行对比分析。研究以PPIs的使用为暴露因素。主要结局定义为在随访期间首次出现需住院治疗或急诊护理的骨折诊断。根据5年随访期间PPI治疗的累计时间,基于治疗总时长来评估骨折风险,使用Poisson模型来估计发病率,使用Cox比例风险回归模型来量化风险率(HR)。

     如Table2所示,PPIs的使用与各类型骨折的风险增加皆有相关性(HR, 1.11 [95% CI, 1.06-1.15])。就骨折位点来说,PPIs组中的患儿发生上肢(HR, 1.08 [95% CI,1.03-1.13])、下肢(HR, 1.19 [95% CI, 1.10-1.29])及其他部位骨折(HR, 1.51 [95% CI, 1.16-1.97])的风险较高。

     由Table3可知,PPIs处理30天及以下组的HRs为1.08 (95% CI, 1.03-1.13), 31至1年的HRs为1.14 (95% CI, 1.09-1.20), 1年以上的HRs为1.34 (95% CI, 1.13-1.58)。

     由年龄相关的亚组分析图可知,在6岁或6岁以上开始进行PPIs的患者中,骨折风险显著增加。6至12岁年龄组和12岁以上年龄组的骨折HRs分别为1.14 (95% CI,1.08-1.22)和1.09 (95% CI,1.03- 1.15)。12岁或12岁以上的患者脊柱骨折(HR, 1.46 [95% CI, 1.01- 2.11])、下肢骨折(HR, 1.21 [95% CI, 1.08-1.35])和其他部位骨折(HR, 1.72 [95% CI, 1.26-2.35])的风险增加。

     研究得出:使用PPIs对儿童骨折风险增加的影响主要限于6岁及以上的儿童;在PPIs使用的累计持续时间较长时,这种影响似乎更为显著,说明随着PPIs使用时间的增加,骨折风险逐渐加大。PPI的使用与任何类型的骨折风险增加都具有微小但重要的相关性,临床医师在权衡儿童PPIs治疗的风险-收益时,应谨慎考虑PPIs导致的骨折的风险。

原始出处:Association Between Proton Pump Inhibitor Use and Risk of Fracture in Children. JAMA Pediatrics,July 8,2020.

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  4. 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level=null, likeNumber=21, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=101695, encryptionId=22c6101695c9, topicName=骨折风险)], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTKnILSXam1GxPwj04ylEzibYLFA2eGl5Ev02klt80JA0xejMPqrn0mYHNNnLEgyqYTPbicXpY3tn6SA/132, createdBy=38fd2500059, createdName=新生儿张玉军, createdTime=Thu Jul 23 12:04:39 CST 2020, time=2020-07-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=803875, encodeId=d5088038e5a4, content=好文学, beContent=null, objectType=article, channel=null, level=null, likeNumber=95, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=acee5401612, createdName=ms7000001773953003, createdTime=Wed Jul 22 11:05:51 CST 2020, time=2020-07-22, status=1, ipAttribution=)]
    2021-05-08 feather89
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level=null, likeNumber=21, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=101695, encryptionId=22c6101695c9, topicName=骨折风险)], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTKnILSXam1GxPwj04ylEzibYLFA2eGl5Ev02klt80JA0xejMPqrn0mYHNNnLEgyqYTPbicXpY3tn6SA/132, createdBy=38fd2500059, createdName=新生儿张玉军, createdTime=Thu Jul 23 12:04:39 CST 2020, time=2020-07-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=803875, encodeId=d5088038e5a4, content=好文学, beContent=null, objectType=article, channel=null, level=null, likeNumber=95, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=acee5401612, createdName=ms7000001773953003, createdTime=Wed Jul 22 11:05:51 CST 2020, time=2020-07-22, status=1, ipAttribution=)]
    2020-12-15 lifefamily

    #质子泵抑制剂#或可增加儿童#骨折#风险,对成人同样如此。

    0

  7. 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level=null, likeNumber=21, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=101695, encryptionId=22c6101695c9, topicName=骨折风险)], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTKnILSXam1GxPwj04ylEzibYLFA2eGl5Ev02klt80JA0xejMPqrn0mYHNNnLEgyqYTPbicXpY3tn6SA/132, createdBy=38fd2500059, createdName=新生儿张玉军, createdTime=Thu Jul 23 12:04:39 CST 2020, time=2020-07-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=803875, encodeId=d5088038e5a4, content=好文学, beContent=null, objectType=article, channel=null, level=null, likeNumber=95, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=acee5401612, createdName=ms7000001773953003, createdTime=Wed Jul 22 11:05:51 CST 2020, time=2020-07-22, status=1, ipAttribution=)]
    2021-02-17 hbwxf
  8. 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    2020-07-26 彭红

    药物即治疗疾病,又致病!

    0

  9. 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    2020-07-22 ms7000001773953003

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