质子泵抑制剂的不良反应，包括引起难辩梭菌感染
翻译：江利冰 校对：肖锋

Title: PPIs--Adverse Effects, Including C. Diff

题目：质子泵抑制剂的不良反应，包括引起难辩梭菌感染
Author 作者: EMedHome.com
 

Proton pump inhibitors are one of the most commonly prescribed classes of medications in the US and the use of PPIs in U.S. EDs has more than doubled from 2001 to 2010. PPIs have recently been associated with several severe adverse effects, including osteoporosis and associated fractures, hypomagnesemia, community-acquired pneumonia, and Clostridium difficile colitis. In addition, some PPIs have significant drug-drug interactions.
质子泵抑制剂在美国是最常用的处方药之一，而且从2001年至2010年，质子泵抑制剂的使用增加了1倍。质子泵抑制剂的使用最近报道和一些不良反应有关，包括骨质疏松以及与之相关的骨折，低镁血症，社区获得性肺炎，以及难辩梭菌结肠炎。除此之外，一些质子泵抑制剂存在明显的药物之间相互作用。
Familiarity with PPI adverse effects allows Emergency Physicians to consider if presenting complaints are related to PPI use, and to be alert to potential complications when considering prescribing a PPI to an ED patient. Of particular note:
熟悉质子泵抑制剂的不良反应，当遇到因使用质子泵抑制剂而出现临床症状时，急诊医师可以考虑为质子泵抑制剂的不良反应，并且在给急诊患者开质子泵抑制剂处方时，应警惕可能发生的并发症。尤其要注意：
Certain PPIs inhibit the CYP2C19 enzyme. For example, the use of omeprazole can decrease the efficacy of clopidogrel which is commonly used after cardiac stent placement, resulting in increased thrombotic risk. This drug-drug interaction has been associated with adverse cardiovascular outcomes.

某些质子泵抑制剂会抑制CYP2C19酶的活性。例如，心脏置入支架的患者，需要使用氯吡格雷，而使用奥美拉唑会减少该药的效能，从而增加血栓发生的风险。这种药物与药物之间的相互作用和不良的心血管结局有关。
Long-term PPI use increases risk of osteoporosis due to a decreased absorption of B12 and calcium. A meta-analysis demonstrated a 30% increase in fractures in patients who use PPIs.

长期使用质子泵抑制剂会增加骨质疏松，因为会减少维生素B12和钙的吸收。一项荟萃分析显示，使用质子泵抑制剂的患者发生骨折的风险增加30%。
Long-term decreases in gastric acidity may lead to C. difficile colitis and PPIs may be contributing to the increase in C. difficile in the community and in patients who have not been exposed to antibiotics. A meta-analysis suggests that PPI’s lead to a 65% increase in the incidence of C. difficile-associated diarrhea.
长期降低胃液酸度，可能导致难辩梭菌性结肠炎，并且质子泵抑制剂的使用可能和社区以及尚未暴漏于抗生素人群难辩梭菌感染增加有关。一项荟萃分析显示质子泵抑制剂的使用发生难辩梭菌性腹泻的风险增加65%。
References 参考文献:

Mazer-Amirshahi M, et al. J of Emerg Med epub, March 24, 2014.

Abraham NS. Curr Opin Gastroenterol 2012;28:615-620.

Vakil N. Drugs 2012;72:437-445.

Famularo G, et al. Expert Opin Drug Saf 2013;12:709-716.

Goodman SG, et al. Circulation 2012;125:978-986.

Ngamruengphong S, et al. Am J Gastroenterol 2011;106:1209-1218.

Chitnis AS, et al. JAMA Intern Med 2013;173:1359-1367.

Janarthanan S, et al. Am J Gastroenterol 2012;107:1001-1010.