H2受体拮抗剂应用与肺炎发生危险的Meta分析

摘要/Abstract

摘要： 目的:评估H2受体拮抗剂(histamine-receptor antagonists ,H2RA)应用是否增加肺炎的发生危险。方法: 应用计算机检索EMBASE 、CENTRAL(the Cochrane central register of controlledtrials)、Medline 、万方数据库、中国生物医学文献数据库系统(CBM)、中国期刊全文数据库(CNKI)等,搜集公开发表的关于H2RA应用与肺炎发生危险的随机对照研究(randomized controled trials, RCT)。以受试者肺炎发生的相对危险度(relative risk, RR)及相应的95%置信区间(95% confidence interval, 95%CI)作为效应指标进行合并统计量。各研究间的统计学异质性采用Q统计量的I²检验来分析,双侧P＞0.05 认为各研究间不存在明显的统计学异质性,采用固定效应模型进行分析,反之采用随机效应模型进行分析。应用Egger法对发表偏倚进行量化检测。结果: 共有18篇研究符合纳入标准,2974例受试者,H2RA组1508例,对照组1466例。Meta分析显示,H2RA可增加受试者肺炎的发生风险(RR=1.22,95%CI=1.05～1.41,Z=2.61,P=0.009);亚组分析,H2RA与安慰剂相比,使受试者的肺炎风险增加21%(RR=1.21, 95%CI=1.02～1.45,Z=2.17,P=0.03),H2RA与硫糖铝相比并不增加受试者肺炎的发生风险(RR=1.22, 95%CI=0.93～1.60,Z=1.45,P=0.148)。结论:H2RA的应用可能是肺炎发生的一个危险因素。

关键词: 肺炎, H2受体拮抗剂, Meta分析

Abstract: AIM: To evaluate whether the use of histamine-receptor antagonists will increase the risk of pneumonia.METHODS: By searching EMBSE , CENTRAL(the Cochrane central register of controlledtrials), CBM, Medline, CNKI and WANFANG et al , we collected published randomized controled trials(RCTs) about histamine use and risk of pneumonia.The effect size was incidence of pneumonia measured relative risk (RR) and its 95% confidence interval (95%CI).The cochran's chi-square test (Q test) was used to test the statistical heterogeneity.The Egger test was used to test the publication bias.RESULTS:18 trials that included a total of 2974 subjects were included in the meta-analysi.1508 subjects were in the histamine-receptor antagonists group and 1466 were in the placebo of sucralfate group.The pooled relative risk of pneumonia was higher in histamine-receptor antagonists group compared with placebo/sucralfate group(RR=1.22,95%CI=1.05-1.41,Z=2.61,P=0.009). Sub-group analysis ,the pneumonia risk was increase 21% in histamine-receptor antagonists group compared with placebo group(RR=1.21, 95%CI=1.02-1.45,Z=2.17,P=0.03).But statistical difference was observed between histamine-receptor antagonists group and sucralfate group RR=1.22, 95%CI=0.93-1.60,Z=1.45, P=0.148).CONCLUSION: The use of histamine-receptor antagonists may increase the risk of pneumonia.

Key words: Pneumonia, Histamine-receptor antagonists, Meta-analyis

中图分类号:

R311

胡爱虹, 李小明, 马欢杰. H2受体拮抗剂应用与肺炎发生危险的Meta分析[J]. 中国临床药理学与治疗学, 2012, 17(5): 536-542.

HU Ai-hong, LI Xiao-ming, MA Huan-jie. A Meta-analysis of histamine-receptor antagonists use and risk of pneumonia[J]. Chinese Journal of Clinical Pharmacology and Therapeutics, 2012, 17(5): 536-542.

参考文献

[1] 陈永荣.奥美拉唑与其他药物治疗消化性溃疡及出血的对照研究meta分析[J].中国临床药理学与治疗学,2005,10(12):1420-1422.
[2] Cheadle WG, Vitale GC, Mackie CR, et al. Prophylactic post-operative nasogastric decompression. A prospective study of its requirement and the influence of cimetidine in 200 patients[J]. Ann Surg, 1985,202(3):361-366.
[3] Apte NM, Karnad DR, Medhekar TP, et al. Gastric colonization and pneumonia in intubated critically ill patients receiving stress ulcer prophylaxis: a randomized, controlled trial[J]. Crit Care Med,1992,20(5):590-593.
[4] Metz CA, Livingston DH, Smith JS, et al. Impact of multiple risk factors and ranitidine prophylaxis on the development of stress-related upper gastrointestinal bleeding: a prospective, multicenter, double-blind, randomized trial. The Ranitidine Head Injury Study Group[J]. Crit Care Med, 1993,21(12):1844-1849.
[5] Pickworth KK, Falcone RE, Hoogeboom JE, et al. Occurrence of nosocomial pneumonia in mechanically ventilated trauma patients: a comparison of sucralfate and ranitidine[J]. Crit Care Med, 1993,21(12):1856-1862
[6] Reusser P, Zimmerli W, Scheidegger D, et al. Role of gastric colonization in nosocomial infections and endotoxemia: a prospective study in neurosurgical patients on mechanical ventilation[J]. J Infect Dis, 1989,160(3):414-421.
[7] Ben-Menachem T, Fogel R, Patel RV, et al. Prophylaxis for stress-related gastric hemorrhage in the medical intensive care unit. A randomized, controlled, single-blind study[J]. Ann Intern Med, 1994,121(8):568-575.
[8] Cloud ML, Offen W. Continuous infusions of nizatidine are safe and effective in the treatment of intensive care unit patients at risk for stress gastritis. The Nizatidine Intensive Care Unit Study Group[J]. Scand J Gastroenterol Suppl, 1994,206:29-34.
[9] Cook D, Guyatt G, Marshall J, et al. A comparison of sucralfate and ranitidine for the prevention of upper gastrointestinal bleeding in patients requiring mechanical ventilation. Canadian Critical Care Trials Group[J]. N Engl J Med, 1998,338(12):791-797.
[10] Hanisch EW, Encke A, Naujoks F, et al. A randomized, doubleblind trial for stress ulcer prophylaxis shows no evidence of increased pneumonia[J]. Am J Surg, 1998,176(5):453-457.
[11] Yildizdas D, Yapicioglu H, Yilmaz HL. Occurrence of ventilatorassociated pneumonia in mechanically ventilated pediatric intensive care patients during stress ulcer prophylaxis with sucralfate, ranitidine, and omeprazole[J]. J Crit Care, 2002,17(4):240-245.
[12] Kantorova I, Svoboda P, Scheer P, et al. Stress ulcer prophylaxis in critically ill patients: a randomized controlled trial[J]. Hepatogastroenterology, 2004,51(57):757-761.
[13] Laggner AN, Lenz K, Base W, et al. Prevention of upper gastrointestinal bleeding in long-term ventilated patients. Sucralfate versus ranitidine[J]. Am J Med, 1989,86(6A):81-84.
[14] Eddleston JM, Vohra A, Scott P, et al. A comparison of the frequency of stress ulceration and secondary pneumonia in sucralfate or ranitidine-treated intensive care unit patients[J]. Crit Care Med, 1991,19(12):1491-1496.
[15] Ryan P, Dawson J, Teres D, et al. Nosocomial pneumonia during stress ulcer prophylaxis with cimetidine and sucralfate[J]. Arch Surg, 1993,128(12):1353-1358.
[16] Maier RV, Mitchell D, Gentilello L. Optional therapy for stress gastritis[J]. Ann Surg, 1994,220(3):353-360.
[17] Mustafa NA, Akturk G, Ozen I, et al. Acute stress bleeding prophylaxis with sucralfate versus ranitidine and incidence of secondary pneumonia in intensive care unit patients[J]. Intensive Care Med, 1995,21(3):287.
[18] Thomason MH, Payseur ES, Hakenewerth AM, et al. Nosocomial pneumonia in ventilated trauma patients during stress ulcer prophylaxis with sucralfate, antacid, and ranitidine[J]. J Trauma, 1996,41(3):503-508.
[19] O'Keefe GE, Gentilello LM, Maier RV. Incidence of infectious complications associated with the use of histamine2-receptor antagonists in critically ill trauma patients[J]. Ann Surg, 1998,227(1): 120-125.
[20] Daachner F,Reusehenbach K,Pfistm'er J,et al.The effect of stress ulcer prevention on the incidence of pneumonia in artificial respiration[J].Anaesthesist,1987,36(1):9-18.
[21] 谷俊东,赵辉,朱思伟,等.卡铂对比顺铂联合第三代化疗药一线治疗晚期NSCLC的Meta分析[J].中国癌症,2010,20(10):726-732.