肺移植受者中长期使用质子泵抑制剂：在20年观察性研究中近乎普遍使用但未对临床结局产生明确影响
Long-Term Proton Pump Inhibitors in Lung Transplant Recipients: Near-Universal Use Without Clear Impact on Clinical Outcomes Over a 20-Year Observational Study.
文献信息
| PMID | 42878165 |
|---|---|
| 原文 | 在 PubMed 查看原文 ↗ |
| 发表日期 | 2026 |
| 作者 | Chen Yang Kevin Zhang |
| 作者单位 | Toronto Lung Transplant Program, Ajmera Transplant Centre, University Health Network, Toronto, Canada. |
| 期刊 | Clinical transplantation |
| SCI 分区 | Q2 |
| IF | 1.9 |
| 研究类型 | 临床研究 · 临床 |
| 所属专科 | 咽喉科 |
中文摘要
背景： 胃食管反流病（GERD）是慢性肺移植物功能障碍（CLAD）的已知危险因素，而CLAD是肺移植受者（LTR）长期生存的主要障碍。虽然质子泵抑制剂（PPI）对GERD的症状治疗有效，但关于长期使用PPI的患病率及其与临床结局相关性的数据很少。
方法： 单中心回顾性队列研究，纳入1999年至2018年间接受首次肺移植的成年受者，且在移植后1年时存活且无CLAD。PPI暴露定义为移植后6个月内开始、第一年内连续使用≥8周。
结果： 共纳入1308例LTR，其中1170例（89.4%）暴露于PPI。PPI使用随时间增加，自2007年起持续高于90%。在多变量分析中，使用PPI的LTR与未使用PPI者相比，发生CLAD的时间和死亡/再移植时间相似。同样，在每日一次与每日两次给药的LTR之间，或在考虑24小时pH-阻抗监测中反流发作次数后，均未观察到结局差异。移植后第一年的支气管肺泡灌洗培养阳性和急性排斥反应也相当。
结论： 长期使用PPI变得近乎普遍，但未观察到对临床结局的明显影响。虽然需要进一步研究，但这些发现对LTR中常规使用PPI提出了质疑。
英文摘要
BACKGROUND: Gastroesophageal reflux disease (GERD) is a known risk factor for chronic lung allograft dysfunction (CLAD), the main barrier to long-term survival in lung transplant recipients (LTR). While proton pump inhibitors (PPI) are effective for symptomatic treatment of GERD, data are sparse on the prevalence of long-term PPI use and association with clinical outcomes.
METHODS: Single-center retrospective cohort of adult first-time LTR between 1999 to 2018 who were alive and CLAD-free at 1-year post-transplant. PPI exposure was defined as ≥8 continuous weeks in the first year, started within 6 months post-transplant.
RESULTS: 1308 LTR were included, with 1170 (89.4%) exposed to PPI. PPI use increased over time and remained above 90% from 2007 onwards. In multivariable analyses, LTR on PPI had similar time to CLAD and time to death/retransplant compared to those not on PPI. Similarly, no differences in outcomes were observed between LTR on once-daily and twice-daily dosing, or after accounting for the number of reflux episodes on 24 h pH-impedance monitoring. Positive bronchoalveolar lavage cultures and acute rejection over the first-year post-transplant was also comparable.
CONCLUSIONS: Long-term use of PPI became near-universal without observable effect on clinical outcomes. While further research is needed, these findings question the routine use of PPI in LTR.