非甾体抗炎药的临床安全性再评价

传统的非甾体类抗炎药（NSAIDs）化学合成已有100多年的历史。由于胃肠道不良反应，其应用受到限制。1999年环氧合酶（COX）-2抑制剂获得美国食品药品管理局（FDA）批准上市。由于其具有传统NSAIDs不具备的优点，近年来在全球以惊人的速度推广。根据美国芝加哥大学Dai等的最新统计资料，COX-2抑制剂占全部NSAIDs的处方比例，已经从1999年的35％增加至2001年和2002年的61％。其中63％可以使用普通NSAIDs的患者，医师给其开具了COX-2抑制剂。     

非甾体抗炎药物的临床应用及安全性评价

目的非甾体抗炎药(NSAIDS)是一类具有镇痛、抗炎、解热等功能的药物,临床应用十分普遍。同时NSAID s不良反应的发生率比较高,尤以胃肠道不良反应最为多见,高达20%～50%。本文旨在探讨NSAIDS的临床应用情况及安全性评价。     

非甾体抗炎药的临床应用及不良反应

目的：探讨非甾体抗炎药的临床应用及不良反应。方法：对50例发生非甾体抗炎药的不良反应的病例资料进行回顾性分析。结果：非甾体抗炎药的不良反应包括胃肠道反应,肝、肾以及血液系统损害等。结论：随着非甾体抗炎药的广泛应用,其不良反应发生的情况较为多见,在使用过程中,临床医生应严加关注,确保用药安全,以减少药物对机体的副作用。     

非甾体抗炎药不良反应特点研究

目的以辽宁省数据库中2006～2007年非甾体抗炎药（NSAIDs）不良反应报告为研究对象,分析发生情况及显著特征。方法采用自发报告系统获取药品不良反应报告,并对相关资料进行处理和分析。结果在27433例药品不良反应报告中,NSAIDs不良反应（NSAIDs-ADRs）1030例（占3.8%）。对不同年龄组的男女比例进行分析表明,在19～39,40～59年龄组有显著的性别差异：男女比例分别为1：1.14和1.19：1。不良反应主要累及器官为胃肠系统损伤;中枢及外周神经系统损伤;视觉损伤;血小板,出血和凝血障碍以及男性生殖系统损伤。NSAIDs-ADRs所致严重病例报告共15例,占严重病例报告总数的比例较低,同时无年龄性别差异。结论应关注NSAIDs的不良反应,提高合理用药水平。     

上海地区非甾体抗炎药不良反应回顾与分析

目的 调查上海市长期使用非甾体抗炎药(NSAIDs)人群药物不良反应发生情况及相关参数。方法 用整群抽样,回顾性询问填表法,获取了1002例患者的基本情况、NSAID s使用情况、合并用药情况和药物不良反应(发生、治疗、预后)等情况。结果 调查显示,患者使用NSAIDs均在1年以上,药物不良反应发生率较高(66％),症状主要集中在胃肠道、皮疹、中枢症状,严重药物不良反应约7％,药物不良反应预后较好。结论 NSAID s药物不良反应受多种因素影响。     

非甾体类抗炎药的不良反应及其预防

非甾体类抗炎药不良反应的发生及表现、危险因素、预防措施等进行了综述。其常见的不良反应有胃肠道损伤、肝肾损伤、中枢神经系统症状、过敏反应等。     

非甾体抗炎药的胃肠道不良反应及防治

非甾体抗炎药 (ＮＳＡＩＤｓ)具有解热、镇痛、消炎作用 ,应用比较广泛。但这类药物不良反应较多 ,其中胃肠道反应最常见 ,也是中断治疗的主要原因。本文将ＮＳＡＩＤｓ对胃肠损害的机制、影响因素及其防治作一综述。1　ＮＳＡＩＤｓ胃肠道不良反应的发生机制ＮＳＡＩＤｓ通过抑制环氧化酶 (ＣＯＸ) ,阻断花生四烯酸转化成前列腺素 (ＰＧ)发挥作用。ＣＯＸ有两种异构体 :ＣＯＸ 1和ＣＯＸ 2。ＣＯＸ 1存在于大多数组织中 ,利用体内花生四烯酸合成ＰＧ ,该ＰＧ对胃的作用是保护胃粘膜。ＣＯＸ 2是在内、外源性损伤刺激后诱导炎症和免疫细胞产…     

非甾体抗炎药不良反应队列研究的样本量估计

目的：估算非甾体抗药不良反应队列研究的样本量，为临床科研设计提供依据。方法：根据研究目的及统计分析计划选择样本量的估算方法，多种估算方法相结合，提出几种方案以供决策和选择。结果：依据文献资料数据以及研究需要解决的问题，计算并给出了多前提条件下的最小观测例数。结论：在考虑样本增量的条件下，根据本研究的具体情况确定每一平行组观测例数为150例，并以此为依据进行实验设计。     

Monitoring of nonsteroidal antiinflammatory drugs

Until now, little or no attention has been paid to the monitoring of therapy with nonsteroidal antiinflammatory drugs (NSAIDs). The authors discuss reasons for that situation. They emphasize that lack of monitoring of unwanted side-effects of the widely used NSAIDs is no doubt due to the overuse of these drugs. The expedience and a protocol concerning the efficacy and toxicity monitoring of such drugs are critically discussed. The authors stress that toxicity monitoring should be performed in selected patient groups that to only in those patients at risk.     

Pseudoporphyria from nonsteroidal antiinflammatory drugs

Pseudoporphyria is a condition in which skin fragility and blistering typical of cutaneous porphyria are associated with normal porphyrin metabolism. Naproxen has recently been described as a cause for drug-induced pseudoporphyria and eight examples of this are reported. We also report instances from ketoprofen and diflunisal.     

Combination use of nonsteroidal antiinflammatory drugs

Polypharmacy with nonsteroidal antiinflammatory drugs (NSAIDs) is widely practiced despite being condemned by many rheumatologist. Combination use of aspirin with other NSAIDs might be discouraged for three well-documented reasons. First, aspirin reduces the blood levels of many NSAIDs. Second, multiple drugs are antagonistic or at least less than additive in animal models of inflammation. Third, there is no good clinical data to suggest that combination use of NSAIDs is beneficial. Unless new studies become available, NSAIDs should be used one at a time, with supplementary analgesics added on a prn basis.     

非甾体类抗炎药与心血管疾病的研究进展

非甾体类抗炎药（NSAIDs）是当今广泛应用的一类药物。目前许多证据表明选择性的环氧化酶-2（COX-2）抑制剂具有不良心血管作用，包括增加心肌梗死、中风、心衰和高血压的危险，对有心血管病史或高心血管疾病危险者上述不良作用可能最为明显。对上述病人，仅在没有可替代的药物时使用COX-2抑制剂，并使用最小的剂量和必需的最短的时间。普通的非选择性的环氧化酶（COX）抑制剂其心血管安全性也有待更多的证据。因此，使用NSAIDs时要注意权衡利弊。     

Safety of non-steroidal anti-inflammatory drugs during pregnancy and lactation

As inhibitors of cyclooxygenase NSAIDs given during pregnancy have the potential to cause adverse maternal and fetal effects. Maternal effects include prolongation of pregnancy and labour, whereas constriction of the ductus arteriosus, renal dysfunction and haemostatic abnormalities can occur in the fetus and neonate. As weak acids, NSAIDs are excreted in small amounts into human breast milk with little risk for adverse effects in the suckling infant.     

Update on sensitivity to nonsteroidal antiinflammatory drugs

Non steroidal antiinflammatory drugs (NSAIDs) are among the most frequently prescribed medications worldwide. These drugs are effective for the treatment of a wide spectrum of diseases: musculoskeletal disorders, headhache, fever, pain, and others. Their widespread use explains the very high incidence of intolerance; reactions range from asthma, rhinitis, to urticaria/angioedema, various skin eruptions and anaphylactic shock. The pathogenesis of intolerance is still unclear: immune-mediated reactions have been reported following the use of pyrazolone derivatives and, less commonly aspirin, anthranilic-acid derivatives and diclofenac. It has been suggested that NSAIDs may induce pseudoallergic reactions, while in case of bronchial asthma the inhibition of cyclooxigenase by NSAIDs has been proposed as a pathogenetic mechanism. The diagnosis of NSAIDs sensitivity can usually be established by history; in fact skin prick tests with NSAIDs have not been successful and no reliable in vitro tests are available. The only definitive diagnostic test is oral test dosing. To identify an alternative NSAIDs in a sensitive patient a tolerance test is performed. Here we review the current state of knowledge concerning NSAIDs sensitivity, including personal data to increase awareness on this issue.     

Induction of hemolytic anemia by nonsteroidal antiinflammatory drugs

The incidence of immune hemolytic anemia (IHA) is increasing. The proliferation of pharmaceuticals is a contributing factor to this increase. IHA is an uncommon, though significant, adverse effect of a wide variety of drugs. Several recent case reports have implicated the nonsteroidal antiinflammatory drugs (NSAIDs). Because of the extensive use of this class of drugs, a review of case reports, clinical studies, and in vitro research was conducted on NSAID-induced IHA. Mefenamic acid, ibuprofen, sulindac, naproxen, tolmetin, feprazone, and aspirin are reported to cause IHA, with mefenamic acid most frequently implicated. Mefenamic acid appears to cause hemolytic anemia by an autoimmune mechanism similar to methyldopa and aspirin by an immune complex mechanism. However, there is insufficient information concerning ibuprofen, sulindac, naproxen, tolmetin, and feprazone to assign specific mechanisms of immune hemolysis. In individuals with glucose-6-phosphate dehydrogenase (G-6-PD) deficiency, aspirin at usual therapeutic doses is not a predisposing factor to hemolysis unless other risk factors are present. Although individuals with G-6-PD deficiency are at increased risk of developing hemolytic anemia when exposed to oxidizing stresses, the use of NSAIDs does not appear to increase this risk significantly. Because NSAID-induced IHA occurs infrequently and the sensitivity of currently used tests to detect drug-dependent antibodies is limited, routine serologic testing in patients receiving NSAIDs is not justified. If hemolytic anemia occurs in a NSAID-treated patient and the history is consistent with a drug-induced etiology, the NSAID should be discontinued. With discontinuation of the offending agent, the prognosis is good. There is a rapid hematologic recovery, with a slow resolution of abnormal serologic findings.     

芳基烷酸类非甾体抗炎药的手性药动学和药效学研究

非甾体抗炎药(nonsteroidal antiinflammatory drugs,NSAIDs)是一类常见的具有抗炎、解热、镇痛及抗风湿作用的药物,临床应用广泛.大多数芳基烷酸类非甾体抗炎药都具有手性,它们的2个对映体在体内的药理活性、代谢过程及不良反应存在显著的差异.文中对常见芳基烷酸类NSAID对映体的药效学和药动学特点,年龄、性别、疾病状态等因素对其药动学过程的影响,以及临床应用进行了综述.     

Certain nonsteroidal antiinflammatory drugs and hospitalization for upper gastrointestinal bleeding

In this follow-up study we attempted to estimate the risk of hospitalization for upper gastrointestinal bleeding (exclusive of bleeding from duodenal ulcer) caused by taking certain nonsteroidal antiinflammatory drugs (NSAIDs) in people below the age of 65 years. The final figures represent our best estimate, taking into account all of the available information, and suggest that NSAIDs (excluding aspirin) rarely cause gastrointestinal bleeding from the stomach that requires hospitalization in this age group. A formal analysis of the data according to classic techniques was not feasible since numerous important confounding factors could not be controlled. Indeed, the results indicated that such formal analysis is unnecessary. The data as they stand are of considerable value in providing a reasonable estimate of attributable risk for the drugs studied.