胃灼熱和胃酸倒流藥物使胃癌的風(fēng)險(xiǎn)增加一倍

胃灼熱和胃酸倒流藥物使胃癌的風(fēng)險(xiǎn)增加一倍

Proton pump inhibitors (PPIs) have an important role in the treatment of Helicobacter pylori. Proton-pump inhibitors (PPIs) are one of the most widely prescribed medications for heartburn and acid reflux worldwide. With profound gastric-acid suppression, concerns about a carcinogenic role in gastric cancer are noted, due to induced hypergastrinemia, gastric atrophy and bacterial overgrowth in the stomach. Daily Proton pump inhibitors usage is associated with a 4.55 times higher risk of cancer than baseline and became as high as an 8-fold greater risk if the drugs were taken for more than three years.

質(zhì)子泵抑制劑(PPIs)在治療幽門(mén)螺桿菌中具有重要作用。質(zhì)子泵抑制劑(PPIs)是世界上最廣泛使用的治療胃灼熱和胃酸倒流的處方藥之一。隨著胃酸的深度抑制，由于誘導(dǎo)的高胃泌素血癥、胃萎縮和胃內(nèi)細(xì)菌的過(guò)度生長(zhǎng)，人們開(kāi)始關(guān)注胃癌的致癌作用。每日使用質(zhì)子泵抑制劑與癌癥風(fēng)險(xiǎn)比基線(xiàn)高4.55倍相關(guān)，如果藥物服用超過(guò)3年，其風(fēng)險(xiǎn)將增加8倍。

These drugs have been in the market for 25 years. Current evidence based on several observational studies suggests PPIs are linked to a greater-than-doubled risk of developing stomach cancer. A study conducted in 2017 revealed that long-term use of the medicine can increase stomach cancer risks by almost 250 percent. People who have an ongoing Helicobacter pylori infection and take a PPI stood a greater chance of developing a precursor to stomach cancer, called atrophic gastritis.

這些藥物已經(jīng)上市25年了。目前基于幾項(xiàng)觀察研究的證據(jù)表明，PPIs與胃癌發(fā)病風(fēng)險(xiǎn)增加一倍以上有關(guān)。2017年進(jìn)行的一項(xiàng)研究顯示，長(zhǎng)期使用這種藥物可使胃癌風(fēng)險(xiǎn)增加近250%?；加杏拈T(mén)螺桿菌持續(xù)感染并服用PPI的人更有可能發(fā)展為胃癌的前體，稱(chēng)為萎縮性胃炎。

In a new study published in the journal Gut, researchers from the University of Hong Kong and University College London, compared the use of PPIs with another drug type used to reduce production of acid termed histamine H2 receptor antagonists (H2 blockers) in 63,397 adults treated with triple therapy (combination of a PPI and two antibiotics to kill off H. pylori over 7 days) for stomach infection with H. pylori bacteria, between 2003 and 2012. Subsequently, these were monitored until they either developed stomach cancer, died, or the study ended (end of December 2015), whichever came first. The average monitoring period lasted 7.5 years.

在《內(nèi)臟》雜志上發(fā)表的一項(xiàng)新研究中，香港大學(xué)和倫敦大學(xué)學(xué)院的研究人員比較了63的PPI與另一種用于減少被稱(chēng)為組胺H2受體拮抗劑(H2阻斷劑)的酸的藥物類(lèi)型的用途。在2003年至2012年間，397名成人接受了三重治療(在7天內(nèi)聯(lián)合使用一種PPI和兩種抗生素殺死幽門(mén)螺桿菌)，以治療幽門(mén)螺桿菌的胃感染。隨后，對(duì)這些人進(jìn)行監(jiān)測(cè)，直到他們要么患上胃癌，要么死亡，要么研究結(jié)束(2015年12月底)，兩者哪個(gè)先發(fā)生。平均監(jiān)測(cè)期為7.5年。

During this mentioned period, 3271 (5%) people took Proton pump inhibitors for an average of nearly 3 years; and 21,729 took H2 blockers. It was seen that Total, 153 (0.24%) people had developed stomach cancer after triple therapy. None of those tested positive for H pylori at that time, but all of them had long standing gastritis (inflammation of the stomach lining). Those who had taken PPIs were linked with doubling and more (2.44) in the risk of developing stomach cancer, while taking H2 blockers was not associated with any such heightened risk. The average time frame in between triple therapy and the developing stomach cancer was under 5 years. The risk was proportional to the duration as well as frequency of usage of PPIs. Frequency of usage (higher usage) was associated with greater risk, daily use was linked to a more than quadrupling in risk (4.55) compared with that of weekly use.

在此期間，3271人(5%)平均服用質(zhì)子泵抑制劑近3年;21729人服用了H2受體阻滯劑。共有153人(0.24%)在接受三聯(lián)療法后患上胃癌。當(dāng)時(shí)沒(méi)有人的幽門(mén)螺桿菌檢測(cè)呈陽(yáng)性，但他們都有長(zhǎng)期的胃炎(胃粘膜的炎癥)。那些服用過(guò)PPIs的人患胃癌的風(fēng)險(xiǎn)增加了一倍甚至更多(2.44)，而服用H2受體阻滯劑的人患胃癌的風(fēng)險(xiǎn)則沒(méi)有增加。在三聯(lián)療法和胃癌之間的平均時(shí)間是5年以下。風(fēng)險(xiǎn)與PPIs的持續(xù)時(shí)間和使用頻率成正比。使用頻率(較高的使用頻率)與更大的風(fēng)險(xiǎn)相關(guān)，每日使用與每周使用相比，風(fēng)險(xiǎn)增加了四倍多(4.55)。

The longer period PPIs were used, the greater was the risk of development of stomach cancer, rising the rate 5-fold after more than a year, to that of more than 6-fold after 2 or more years, and that of more than 8-fold after 3 or more years. Long-term using of PPIs was associated with around 4 additional cases of stomach cancer per 10,000 people per year.

PPIs使用的時(shí)間越長(zhǎng)，胃癌的發(fā)展風(fēng)險(xiǎn)越大，一年多以后，胃癌發(fā)病率上升5倍，兩年以上以后，上升到6倍以上，三年以上以后，上升到8倍以上。PPIs的長(zhǎng)期使用與每年每1萬(wàn)人中增加4例胃癌有關(guān)。

Research done previously has linked long-term use of PPI to a number of other health problems including increased risk of heart attack, dementia, kidney problems, bone fractures, and tendon and ligament tears, and this study adds stomach cancer to the list of increased risks and dangerous side effects accompanying prolonged PPI-use. Even after the bacteria was killed, those who had taken PPIs on a long-term basis were more likely to develop stomach cancer in the following 7 to 8 years of follow-up. However, it could not tell if PPIs were the cause of the increased stomach cancer risk. It could also have been down to other factors.

先前的研究已經(jīng)將長(zhǎng)期使用PPI與許多其他健康問(wèn)題聯(lián)系起來(lái)，包括心臟病發(fā)作、癡呆、腎臟問(wèn)題、骨折、肌腱和韌帶撕裂的風(fēng)險(xiǎn)增加，本研究將胃癌列入長(zhǎng)期使用PPI增加的風(fēng)險(xiǎn)和危險(xiǎn)副作用的清單。即使在細(xì)菌被殺死后，那些長(zhǎng)期服用PPIs的人在接下來(lái)的7到8年的隨訪(fǎng)中更容易患上胃癌。然而，它不能確定PPIs是否是胃癌風(fēng)險(xiǎn)增加的原因。這也可能是其他因素造成的。

The causation of developing stomach cancer is multifactorial. The reasonable explanation for the totality of evidence presented on this is that those who were given PPIs, and especially those who continued them for a longer period, tend to be sicker in a variety of ways than those for whom they are not prescribed. Hence, they are more likely to develop cancer anyway.

胃癌的發(fā)病是多因素的。對(duì)這方面所提出的全部證據(jù)的合理解釋是，那些被給予PPIs的人，特別是那些長(zhǎng)期服用PPIs的人，往往在各種方面比那些沒(méi)有被給予PPIs的人更容易患病。因此，無(wú)論如何，他們更容易患上癌癥。

Hence, it is recommended to reduce the consumption of PPIs to the minimum required period. Dietary and lifestyle changes are preferred to reduce the acid reflux, which will have a prolonged result with reduced risk for development of stomach cancer.

因此，建議將PPIs的消耗量減少到所需的最短時(shí)間。飲食和生活方式的改變有利于減少胃酸倒流，這將有一個(gè)長(zhǎng)期的結(jié)果，降低胃癌的發(fā)展風(fēng)險(xiǎn)。