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【drug-news】Some Acid-Reflux Drugs Tied to Pneumonia 制酸药与患肺炎有关

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原文链接： http://www.nytimes.com/2009/05/27/health/27drugs.html?ref=health

Some Acid-Reflux Drugs Tied to Pneumonia

By RONI CARYN RABIN
Published: May 26, 2009

A growing number of hospital patients are routinely given drugs to prevent acid reflux. But a new study has found that patients who take these so-called proton pump inhibitors are at higher risk for pneumonia than those who do not.
The drugs — including Nexium, Prilosec and Prevacid — are often recommended for intensive-care patients to prevent stress ulcers, and in recent years they have been given to many other hospital patients, in large part because they are widely perceived to be safe. Experts estimate that 40 percent to 70 percent of inpatients now receive acid-suppressive drugs during a hospital stay, with about half receiving them for the first time.
“I noticed that there were a lot of patients being placed on these for prophylactic purposes, and I thought that was curious because they are not currently recommended for patients who aren’t at high risk for stress ulcers,” said the study’s lead author, Dr. Shoshana J. Herzig, chief medical resident at Beth Israel Deaconess Medical Center in Boston, explaining why she was interested in the subject.
Dr. Herzig said that proton pump inhibitors, which suppress acid in the stomach, might promote the growth of different types of bacteria in the upper gastrointestinal and respiratory tract, and that those bacteria might be the culprits in the pneumonias. Another explanation, she suggested, may be that acid stimulates coughing, and coughing less may promote pneumonia.
The study, published in The Journal of the American Medical Association this week, analyzed 63,878 admissions to Beth Israel Deaconess from Jan. 1, 2004, to Dec. 31, 2007. All of the records belonged to adults hospitalized for three days or more, who had not been in intensive care. Acid-suppressive drugs were ordered for just over half of the patients.
Among patients who received the drugs, 4.9 percent developed pneumonia in the hospital — more than double the 2 percent who had not been given the drugs. After adjusting to account for the fact that recipients of the drugs may have been sicker to begin with, the researchers determined that patients treated with acid-reflux drugs faced a 30 percent increase in pneumonia risk over patients who were not.
The increase in pneumonia was not seen among patients who took a type of acid-reflux drug known as histamine-2 receptor antagonists, sold under names like Pepcid and Zantac.
A spokesman for AstraZeneca, which makes Nexium, also known as “the purple pill,” said the study had limitations and could not definitively show that the drug caused excess pneumonia.
Earlier reports have linked proton pump inhibitors to other complications, including community-acquired pneumonia, hip fractures and diarrhea associated with Clostridium difficile.
Although the drugs are used to prevent stress ulcers, “a lot of people don’t need to be on them in the first place, and they’re sent home on them and stay on them,” said Dr. Joel J. Heidelbaugh of the University of Michigan. He added that such inappropriate use of the drugs drove up the costs of health care.

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2009-05-27 23:59 浏览 : 1929 回复 : 7

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Some Acid-Reflux Drugs Tied to Pneumonia
抑酸药物与肺炎的关系
By RONI CARYN RABIN
Published: May 26, 2009

A growing number of hospital patients are routinely given drugs to prevent acid reflux. But a new study has found that patients who take these so-called proton pump inhibitors are at higher risk for pneumonia than those who do not.
目前越来越多的住院病人常规使用防止胃酸返流的药物。但是一项研究发现那些使用质子泵抑制剂的患者比不使用的患者患肺炎的风险更大。
The drugs — including Nexium, Prilosec and Prevacid — are often recommended for intensive-care patients to prevent stress ulcers, and in recent years they have been given to many other hospital patients, in large part because they are widely perceived to be safe. Experts estimate that 40 percent to 70 percent of inpatients now receive acid-suppressive drugs during a hospital stay, with about half receiving them for the first time.
包括耐信、奥美拉唑和兰索拉唑等一些药物经常作为防止重症监护病房患者发生应激性溃疡的推荐药物，近些年来这些药物经常被用在很多其他住院病人身上因为人们普遍认为他们是安全的。专家估计40-70%的住院病人在住院期间使用过抑酸药物，有一半人是第一次使用。
“I noticed that there were a lot of patients being placed on these for prophylactic purposes, and I thought that was curious because they are not currently recommended for patients who aren’t at high risk for stress ulcers,” said the study’s lead author, Dr. Shoshana J. Herzig, chief medical resident at Beth Israel Deaconess Medical Center in Boston, explaining why she was interested in the subject.
“我注意到很多病人使用这些药是为了预防的目的，我感到很奇怪因为目前这些药物不推荐给没有应激性溃疡危险的病人使用”，研究组的负责人来自波士顿Beth Israel Deaconess医疗中心的主治医师Shoshana J. Herzig博士在解释她为何对这个课题感兴趣时说。
Dr. Herzig said that proton pump inhibitors, which suppress acid in the stomach, might promote the growth of different types of bacteria in the upper gastrointestinal and respiratory tract, and that those bacteria might be the culprits in the pneumonias. Another explanation, she suggested, may be that acid stimulates coughing, and coughing less may promote pneumonia.
Dr. Herzig说质子泵抑制剂可以抑制胃内的胃酸从而促进消化道和呼吸道内各种菌群生长，这些细菌有可能导致肺炎。另一种解释是，酸可以刺激咳嗽反射，咳嗽减少也可以促使肺炎发生。
The study, published in The Journal of the American Medical Association this week, analyzed 63,878 admissions to Beth Israel Deaconess from Jan. 1, 2004, to Dec. 31, 2007. All of the records belonged to adults hospitalized for three days or more, who had not been in intensive care. Acid-suppressive drugs were ordered for just over half of the patients.
本周发表在美国医学会杂志的研究文章分析从2004年1月1日至2007年12月31日间在Beth Israel Deaconess住院3天以上的病人，一共收集63,878例，均未在重症监护病房治疗过。抑酸药物仅给予其中一半病人。
Among patients who received the drugs, 4.9 percent developed pneumonia in the hospital — more than double the 2 percent who had not been given the drugs. After adjusting to account for the fact that recipients of the drugs may have been sicker to begin with, the researchers determined that patients treated with acid-reflux drugs faced a 30 percent increase in pneumonia risk over patients who were not.
住院期间在使用药物的患者中4.9%患肺炎这比未用药患者中2%的肺炎发病率高两倍。后来解释因为患者可能有恶心症状才使用抑酸药，研究者表示给予抑酸药患者比未用抑酸药患者将面对肺炎发生率增高30%的风险。
The increase in pneumonia was not seen among patients who took a type of acid-reflux drug known as histamine-2 receptor antagonists, sold under names like Pepcid and Zantac.
使用组胺2受体拮抗剂的患者未见肺炎发生率增高，这些药物的商品名为法莫替丁和雷尼替丁。
A spokesman for AstraZeneca, which makes Nexium, also known as “the purple pill,” said the study had limitations and could not definitively show that the drug caused excess pneumonia.
来自生产“紫色药片” 耐信的AstraZeneca的一位发言人表示此研究有局限性，不能说药物可以引起肺炎发生率增高。
Earlier reports have linked proton pump inhibitors to other complications, including community-acquired pneumonia, hip fractures and diarrhea associated with Clostridium difficile.
Although the drugs are used to prevent stress ulcers, “a lot of people don’t need to be on them in the first place, and they’re sent home on them and stay on them,” said Dr. Joel J. Heidelbaugh of the University of Michigan. He added that such inappropriate use of the drugs drove up the costs of health care.
早期有报道称质子泵抑制剂可引起其它并发症，如社区获得性肺炎，髋骨折，艰难梭菌相关性腹泻。尽管这些药物用来预防应激性溃疡，但是很多人不必立即使用并且回家后持续使用，密西根大学的Dr. Joel J. Heidelbaugh说。他补充道这种不合规范的用药受健康中心的利益驱动。

编译
Some Acid-Reflux Drugs Tied to Pneumonia
抑酸药物与肺炎的关系
By RONI CARYN RABIN
Published: May 26, 2009

目前越来越多的住院病人常规使用防止胃酸返流的药物。但是一项研究发现那些使用质子泵抑制剂的患者比不使用的患者患肺炎的风险更大。

包括耐信、奥美拉唑和兰索拉唑等一些药物经常作为防止重症监护病房患者发生应激性溃疡的推荐药物，近些年来这些药物经常被用在很多其他住院病人身上因为人们普遍认为他们是安全的。专家估计40-70%的住院病人在住院期间使用过抑酸药物，有一半人是第一次使用。

“我注意到很多病人使用这些药是为了预防的目的，我感到很奇怪因为目前这些药物不推荐给没有应激性溃疡危险的病人使用”，研究组的负责人来自波士顿Beth Israel Deaconess医疗中心的主治医师Shoshana J. Herzig博士在解释她为何对这个课题感兴趣时说。

Dr. Herzig说质子泵抑制剂可以抑制胃内的胃酸从而促进消化道和呼吸道内各种菌群生长，这些细菌有可能导致肺炎。另一种解释是，酸可以刺激咳嗽反射，咳嗽减少也可以促使肺炎发生。

本周发表在美国医学会杂志的研究文章分析从2004年1月1日至2007年12月31日间在Beth Israel Deaconess住院3天以上的病人，一共收集63,878例，均未在重症监护病房治疗过。抑酸药物仅给予其中一半病人。

住院期间在使用药物的患者中4.9%患肺炎这比未用药患者中2%的肺炎发病率高两倍。后来解释因为患者可能有恶心症状才使用抑酸药，研究者表示给予抑酸药患者比未用抑酸药患者将面对肺炎发生率增高30%的风险。

使用组胺2受体拮抗剂的患者未见肺炎发生率增高，这些药物的商品名为法莫替丁和雷尼替丁。

来自生产“紫色药片”耐信的AstraZeneca的一位发言人表示此研究有局限性，不能说药物可以引起肺炎发生率增高。

早期有报道称质子泵抑制剂可引起其它并发症，如社区获得性肺炎，髋骨折，艰难梭菌相关性腹泻。尽管这些药物用来预防应激性溃疡，但是很多人不必立即使用并且回家后持续使用，密西根大学的Dr. Joel J. Heidelbaugh说。他补充道这种不合规范的用药受健康中心的利益驱动。

2009-06-03 07:06

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