| 摘要: | 異位性皮膚炎 (Atopic dermatitis, AD; Atopic eczema, AE) 為一種慢性、極具搔癢感且會反覆發生的皮膚疾病，多好發在嬰兒及孩童族群，全球盛行率約一至兩成，研究顯示其盛行率正逐年攀升。目前致病機轉尚不明確，免疫功能失調可能為成因之一，而胃腸道器官在免疫調節中扮演極重要角色，若腸道機能及環境因藥物、疾病或其他因素受到影響而改變甚至受損，則可能干擾正常免疫調節功能，進而使得異位性皮膚炎等過敏性疾病的發生機率提高。
胃酸分泌抑制藥物中主要兩個大類分別為第二型組織胺受體拮抗劑(Histamine 2 receptor antagonists, H2RAs) 與氫離子幫浦抑制劑 (Proton-pump inhibitors, PPIs)，此兩類藥物皆可應用於上消化道相關疾病(Upper gastrointestinal disease, Upper GID)，如：胃食道逆流 (Gastroesophageal reflux disease, GERD) 及消化道潰瘍 (Peptic ulcer, PU) 之治療或預防。自1980年代後期，尤以PPIs類藥物因其優越的胃酸分泌抑制功效，及高安全性與低副作用之特性而被大量處方。然而近年來，越來越多研究指出其可能具有特定之潛在風險，如骨折、肺炎及腸道感染等，其背後確實的機轉仍不明確，猜測可能與胃酸分泌抑制藥物提升腸胃道整體酸鹼值，進而改變腸道正常之吸收功能或菌叢生態相關。
由於目前仍缺乏有關胃酸分泌抑制藥物及異位性皮膚炎發生率關聯性之相關研究，因此我們執行了這項在台灣的回溯性世代研究，試圖瞭解並比較因上消化道相關疾病而使用胃酸分泌抑制劑藥物的患者與未使用藥物之患者其後續罹患異位性皮膚炎之風險。
Atopic dermatitis (AD) is a chronic, pruritus and relapsing skin disorder, which occurs mostly in infants and children. The global prevalence of AD is approximately 10~20 % and the increasing prevalence of AD has been observed in several studies. The pathogenesis of AD is still unknown, immune dysregulation may be one of the possible causes. Since the gastrointestinal tract (GI tract) plays a significant role in immunomodulation, changes in its function and microenvironment influenced or caused by drugs, diseases, or any other factors may interfere with the normal immune response, resulting in higher incidence of allergic diseases such as AD.
Two main categories of acid-suppressive drugs are histamine 2 receptor antagonists (H2RAs) and proton-pump inhibitors (PPIs), which can be used to treat or prevent upper gastrointestinal diseases (GID), such as gastroesophageal reflux disease (GERD) and peptic ulcer (PU). Since the late 1980s, PPIs are abundantly prescribed due to their excellent acid suppressive effect, high safety and minimal side effects. However, in recent years, there are growing concerns about the association between PPIs use and several potential adverse effects, including fracture, pneumonia and enteric infection. The actual underlying mechanism remains unclear. It is supposed that acid-suppressive drugs may raise the pH level of GI tract, subsequently, changing the normal absorption function or the ecology of microbiota in GI tract.
Currently, studies on the association between the use of acid-suppressive agents and the risk of AD are scarce, thus we conducted a retrospective cohort study in Taiwan, attempting to understand the impact of acid-suppressive drugs on the development of AD in patients with upper GID. |
