【资讯】长期使用质子泵抑制剂增加严重肾损伤风险

最新研究表明，长期服用某些治疗胃灼热、胃酸反流和溃疡的药物可损害肾脏。研究发表在《美国肾脏病学会杂志》。

质子泵抑制剂（PPI）可减少胃酸分泌，据估计，2013年有1500万美国患者被处方该药。但该数据很可能低于实际情况，因PPI也可在药店直接购买，无需处方。

研究者表示：“研究结果强调了限制PPI使用的重要性，仅在有医疗需要时使用，并将用药时间控制在最短期限内。很多患者因身体状况开始服用PPI，且在无需服用后仍继续服用。”

研究采用美国退伍军人事务部数据库信息，纳入173 321例新服用PPI的患者，以及20 270例新服用组胺H2受体阻滞剂（一种用于抑制胃酸的替代类药物）的患者。

随访5年发现，相比H2受体阻滞剂，服用PPI的患者肾功能减退的风险增加。同时，PPI服用者的慢性肾脏病（CKD）风险增加28%，肾衰竭风险增加96%。此外，PPI服用时长与罹患肾病风险有等级性关联，时间越长，罹患肾脏病的风险越高。

研究结果表明，长期服用PPI可能对肾脏造成损伤，应避免使用。使用PPI不仅可增加CKD风险，并可增加其进展至肾衰竭的风险。

之前JAMA内科学杂志上发表的一项研究也得出类似结果。在这项研究中，研究者分析了两组人群：一组为ARIC研究中的10 482例患者，中位随访13.9年，入组时有322例患者使用PPI；另一组为宾夕法尼亚盖辛格医疗系统中的24 8751位研究对象，中位随访6.2年，入组时有16 900位患者使用PPI。

研究发现，ARIC研究中，PPI使用者新发CKD风险明显升高45%。校正混杂因素后，PPI使用者新发CKD风险升高50%。而且PPI既往使用者的CKD风险也增加35%。

在盖辛格医疗系统人群中也观察到，PPI使用者中CKD发生率明显高于不使用者。

来源：

1. Commonly used reflux, ulcer medication may cause serious kidney damage. ScienceDaily

2. Y. Xie, B. Bowe, T. Li, H. Xian, S. Balasubramanian, Z. Al-Aly. Proton Pump Inhibitors and Risk of Incident CKD and Progression to ESRD. Journal of the American Society of Nephrology, 2016; DOI:10.1681/ASN.2015121377

3. Lazarus B, Chen Y, Wilson FP, et al. Proton Pump Inhibitor Use and the Risk of Chronic Kidney Disease.JAMA Intern Med，2016，11:238-246.

附英文原文：

Commonly used reflux, ulcer medication may cause serious kidney damage

New research indicates that long-term use of certain medications commonly used to treat heartburn, acid reflux, and ulcers can have damaging effects on the kidneys. The findings come from a study appearing in an upcoming issue of the Journal of the American Society of Nephrology (JASN).

In 2013, an estimated 15 million Americans were prescribed proton pump (PPIs), which reduce gastric acid production. This number is likely an underestimate because the medications are also available over-the-counter and can be purchased without prescription.

To assess the safety of this widely used drug class, a team led by Yan Xie, MPH and Ziyad Al-Aly, MD, FASN (Clinical Epidemiology Center at the VA Saint Louis Health Care System and Washington University in Saint Louis) analyzed information from the Department of Veterans Affairs national databases. The investigators identified 173,321 new users of PPIs and 20,270 new users of histamine H2 receptor blockers, an alternative class of drugs also used to suppress stomach acid. Over 5 years of follow-up, those taking PPIs were more likely to experience kidney function decline than those taking H2 receptor blockers. PPI users also had a 28% increased risk of developing chronic kidney disease and a 96% increased risk of developing kidney failure. Furthermore, there was a graded association between duration of PPI use and risk of kidney problems, with those who took PPIs for a longer time being more likely to develop kidney issues.

The findings suggest that long-term use of PPIs may be harmful to the kidneys and should be avoided. PPI use may not only increase the risk of developing chronic kidney disease, but may also increase the risk of its progression to complete kidney failure. 'The results emphasize the importance of limiting PPI use only when it is medically necessary, and also limiting the duration of use to the shortest duration possible,' said Dr. Al-Aly.' A lot of patients start taking PPIs for a medical condition, and they continue much longer than necessary.'

The results also provide insightsfor future investigations on drug safety. 'The study serves as a model to leverage the availability of Big Data -- with VA data being a prime example -- and advanced analytics to determine long term safety profiles of commonly used medications and promote pharmacovigilance,' said Xie.

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