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APT:质子泵抑制剂可增加肠道感染易感性

来源:医脉通 2012-04-12 17:07

近日,Alimentary pharmacology & therapeutics发表了美国研究人员的综述文章。此篇系统综述的目的是通过已发表的文献,研究PPI的使用与对特定病原体引起的肠道感染的易感性之间的关系,并讨论PPI增加肠道感染发病的潜在机制。

质子泵抑制剂(PPIs)的使用在全球范围内不断增加,通过抑制胃酸改变了肠道病原体易感性。

得出的结论是由于PPI的使用导致的严重胃酸过少,导致细菌定植并增加了对肠道细菌感染的易感性。医生们应该考虑在服用抗生素的住院患者及去往腹泻发病率高的地区的旅行者中长期使用PPI的临床意义。

本研究使用的方法是对PUBMED、OVID Medline数据库进行搜索。搜索词包括质子泵抑制剂及其机制、作用、胃酸、肠道感染、腹泻、难辨梭状芽孢杆菌、沙门氏菌、志贺氏菌和弯曲杆菌。

结果发现使用PPIs导致胃液pH值升高,促进肠道菌群的生长,增加细菌易位,并且改变多种免疫调节和抗炎作用。肠道致病菌显示出不同的胃酸pH值易感性和耐酸程度。通过多种机制,PPIs似乎可增加以下肠道病原体的易感性:沙门氏菌、空肠弯曲杆菌、大肠埃希氏菌、难辨梭状芽孢杆菌、霍乱弧菌、李斯特菌。研究人员发现了由于PPI的使用,对由沙门氏菌、弯曲杆菌和艰难梭菌引起的肠道感染的易感性增强的证据,三个有机体调整后的相对危险度范围分别为4.2-8.3(两项研究);3.5-11.7(四个研究)和1.2-5.0(27项研究中的17项)。(生物谷Bioon.com)

Systematic review: the use of proton pump inhibitors and increased susceptibility to enteric infection

C. Bavishi1, H. L.

Background The use of proton pump inhibitors (PPIs) is increasing worldwide. Suppression of gastric acid alters the susceptibility to enteric bacterial pathogens.

Aim This systematic review was undertaken to examine the relationship between PPI use and susceptibility to enteric infections by a specific pathogen based on published literature and to discuss the potential mechanisms of PPI enhanced pathogenesis of enteric infections.

Methods PubMed, OVID Medline Databases were searched. Search terms included proton pump inhibitors and mechanisms of, actions of, gastric acid, enteric infections, diarrhoea, Clostridium difficile, Salmonella, Shigella and Campylobacter.

Results The use of PPIs increases gastric pH, encourages growth of the gut microflora, increases bacterial translocation and alters various immunomodulatory and anti-inflammatory effects. Enteric pathogens show variable gastric acid pH susceptibility and acid tolerance levels. By multiple mechanisms, PPIs appear to increase susceptibility to the following bacterial enteropathogens: Salmonella, Campylobacter jejuni, invasive strains of Escherichia coli, vegetative cells of Clostridium difficile, Vibrio cholerae and Listeria. We describe the available evidence for enhanced susceptibility to enteric infection caused by Salmonella, Campylobacter and C. difficile by PPI use, with adjusted relative risk ranges of 4.2–8.3 (two studies); 3.5–11.7 (four studies); and 1.2–5.0 (17 of 27 studies) for the three respective organisms.

Conclusions Severe hypochlorhydria generated by PPI use leads to bacterial colonisation and increased susceptibility to enteric bacterial infection. The clinical implication of chronic PPI use among hospitalized patients placed on antibiotics and travellers departing for areas with high incidence of diarrhoea should be considered by their physicians.

 

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