冠心病患者使用PPI會增加氣喘的風險：基於一人群世代的研究

背景:觀察性研究發現制酸劑藥物的使用與新生氣喘之間有相關性。然而，使用氫離子幫浦阻斷劑(PPI)與新生氣喘之間的關聯性尚不清楚，因此，我們的研究目的旨在探討PPI的使用與新生氣喘的關係，也探討使用PPI的冠狀動脈心臟疾病患者與新生氣喘間的關係。研究方法與結果:本研究為全國性的世代研究，使用台灣健保資料庫收集了2004年1月1日至2013年12月31日的就醫資料。研究的主要結果是通過估計風險比(HRs)和95%信賴區間(CIs)來評估氣喘的風險。使用多元Cox比例風險回歸來估計調整後(aHR)氣喘的發展。還進行了次族群分析(Subgroup analysis)和敏感度分析(sensitivity tests)。結果:使用PPI組有8,894名患者，將13,504名未使用PPI者作為對照組。與未使用PPI組相比，在調整性別、年齡、都市化、低收入以及共病症後，沒有發現使用PPI組與新生氣喘風險之間存在關聯(HR: 1.00; 95% CI: 0.88–1.13)。次族群分析顯示，與未使用PPI組相比，使用PPI組冠狀動脈心臟疾病患者新生氣喘風險增加(HR: 1.44; 95% CI: 1.07–1.93)。結論:未發現使用PPI與新生氣喘之間的有關聯。然而，PPI的使用會增加了冠狀動脈心臟疾病(CAD)患者新生氣喘的風險。在臨床中應衡量PPI和aspirin在治療冠狀動脈心臟疾病(CAD)患者時，應考慮新生氣喘發生的風險。

Background:Observational studies have found a significant association between acid-suppressive drug use and incident asthma. However, the association between proton pump inhibitors (PPIs) and incident asthma is unclear. Thus, this study aimed to determine the association between PPI use and incident asthma. It also aimed to investigate the association of PPI exposure with risk of asthma in patients with coronary artery disease (CAD).Methods and results:This nationwide cohort study collected claims data from the National Health Insurance Review and Assessment Service database in Taiwan from January 1, 2004 to December 31, 2013. The primary outcome assessed was the risk of asthma by estimating hazard ratios (HRs) and 95% confidence intervals (CIs). Multiple Cox regression was used to estimate the adjusted HR of asthma development. Subgroup analysis and sensitivity tests were also conducted. The PPI group included 8894 patients, and 13,504 non-PPI users served as controls. No association was found between PPI use and the risk of incident asthma compared with non-PPI use after adjusting for sex, age, urbanization, low income, and comorbidities (HR: 1.00; 95% CI: 0.88–1.13). Subgroup analysis revealed an increased risk in the PPI group compared with the non-PPI group in patients with CAD (HR: 1.44; 95% CI: 1.07–1.93).Conclusions:No association was found between PPI use and incident asthma. However, PPI use increased the risk of asthma development in patients with CAD. Risk of incident asthma should be considered when weighing the benefits and risks of PPI and aspirin treatment in patients with CAD in clinical practice.