摘要

BACKGROUND: Some evidence suggests that proton pump inhibitors (PPIs) are an under-appreciated risk factor for hypomagnesemia. Whether hospitalization with hypomagnesemia is associated with use of PPIs is unknown. METHODS AND FINDINGS: We conducted a population-based case-control study of multiple health care databases in Ontario, Canada, from April 2002 to March 2012. Patients who were enrolled as cases were Ontarians aged 66 years or older hospitalized with hypomagnesemia. For each individual enrolled as a case, we identified up to four individuals as controls matched on age, sex, kidney disease, and use of various diuretic classes. Exposure to PPIs was categorized according to the most proximate prescription prior to the index date as current (within 90 days), recent (within 91 to 180 days), or remote (within 181 to 365 days). We used conditional logistic regression to estimate the odds ratio for the association of outpatient PPI use and hospitalization with hypomagnesemia. To test the specificity of our findings we examined use of histamine H2 receptor antagonists, drugs with no causal link to hypomagnesemia. We studied 366 patients hospitalized with hypomagnesemia and 1,464 matched controls. Current PPI use was associated with a 43% increased risk of hypomagnesemia (adjusted odds ratio, 1.43; 95% CI 1.06-1.93). In a stratified analysis, the risk was particularly increased among patients receiving diuretics, (adjusted odds ratio, 1.73; 95% CI 1.11-2.70) and not significant among patients not receiving diuretics (adjusted odds ratio, 1.25; 95% CI 0.81-1.91). We estimate that one excess hospitalization with hypomagnesemia will occur among 76,591 outpatients treated with a PPI for 90 days. Hospitalization with hypomagnesemia was not associated with the use of histamine H2 receptor antagonists (adjusted odds ratio 1.06; 95% CI 0.54-2.06). Limitations of this study include a lack of access to serum magnesium levels, uncertainty regarding diagnostic coding of hypomagnesemia, and generalizability of our findings to younger patients. CONCLUSIONS: PPIs are associated with a small increased risk of hospitalization with hypomagnesemia among patients also receiving diuretics. Physicians should be aware of this association, particularly for patients with hypomagnesemia. Please see later in the article for the Editors' Summary.

译文

背景: 一些证据表明质子泵抑制剂 (PPIs) 是一个未被重视的低镁血症的危险因素。低镁血症住院是否与 PPIs 的使用相关尚不清楚。方法和结果: 从 2002年4月到 2012年3月,我们在加拿大安大略省的多个医疗保健数据库中进行了一项基于人群的病例对照研究。纳入病例的患者是年龄在 66 岁或以上的住院低镁血症患者。对于作为病例登记的每个个体,我们确定了多达四个个体作为年龄、性别、肾脏疾病和各种利尿剂使用类别相匹配的对照。暴露于 PPIs 是根据最接近的处方分类的,在指数日期之前是当前的 (90 天内),最近的 (91 到 180 天内), 或远程 (181 至 365 天内)。我们使用条件 logistic 回归来估计门诊 PPI 使用和住院治疗与低镁血症的关联的比值比。为了测试我们发现的特异性,我们检查了组胺 H2 受体拮抗剂的使用,这种药物与低镁血症没有因果关系。我们研究了 366 名低镁血症住院患者和 1,464 名匹配的对照组。目前 PPI 的使用与低镁血症风险增加 43% 相关 (调整后的比值比,1.43; 95% CI 1.06-1.93)。在分层分析中,接受利尿剂的患者的风险尤其增加,(调整后的比值比,1.73; 95% CI 1.11-2.70) 并且在没有接受利尿剂的患者中不显著 (调整后的比值比,1.25; 95% CI 0.81-1.91)。我们估计,在 76,591 名接受 PPI 治疗 90 天的门诊患者中,将出现一次低镁血症过度住院。低镁血症住院与组胺 H2 受体拮抗剂的使用无关 (调整比值比 1.06; 95% CI 0.54-2.06)。这项研究的局限性包括缺乏获得血清镁水平的途径,关于低镁血症诊断编码的不确定性,以及我们的发现对年轻患者的普遍性。结论: 在同时接受利尿剂的患者中,PPIs 与低镁血症住院风险小幅增加有关。医生应该意识到这种联系,尤其是对于低镁血症患者。请参见文章后面的编辑总结。

Hypomagnesemia

内分泌 电解质紊乱 疾病
概述  :  

镁缺乏症是一种电解质紊乱,其中体内的镁含量较低,它可能导致多种症状,症状包括震颤,协调不力,肌肉痉挛,食欲不振,性格改变和眼球震颤等,并发症可能包括癫痫发作或心脏骤停,例如来自尖端扭转型室速。镁含量低的人常常钾含量也低。原因包括低饮食摄入,酗酒,腹泻,肠道吸收不良和糖尿病等,许多药物也可能引起低镁血症。原因①药物:噻嗪类利尿剂的使用;抗生素的使用;长期使用质子泵抑制剂。②遗传学:Gitelman样疾病,其包括引起综合征遗传突变在SLC12A3,CLNCKB, BSND,KCNJ10,FXYD

hypomagnesemia   英 /'haipə,mæɡnə'si:miə/

释    义   n. (美)低镁症;(尤指牛的)血镁过少

例    句   The incidence of hypomagnesemia was significantly higher in patients with arrhythmias than those without, the percentages of incidence were 83.9 and 26.6 (P<0.001) respectively.在这些心律失常患者中,低镁血症明显多于无心律失常患者,分别占83.9%与26.6%(P<0.001)。

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