非甾体类抗炎药物与消化性溃疡出血的关系

目的探讨非甾体类抗炎药物(NSAIDs)诱发消化性溃疡出血的临床流行病学特点。方法回顾分析1991~2004年我院诊治的消化性溃疡出血的临床资料,并用电脑数据库处理分析。结果在694例消化性溃疡并出血患者中,26.80%近期内有服用NSAIDs史。服用NSAIDs组与未服用NSAIDs组比较,服用NSAIDs组前驱症状(腹痛、消化不良等)发生率较低(30.65%比61.42%P<0.01);平均年龄较大[(44.16±13.25)岁比(35.23±11.49)岁,P<0.05];女性比例相对较多(26.34%比15.55%,P<0.01);胃溃疡比例较高(28.50%比20.67%,P<0.01);外科手术率无明显差别(P>0.05);结论NSAIDs是诱发消化性溃疡出血的一常见原因,应加强对NSAIDs胃肠毒副作用的防治。     

非甾体抗炎药致消化性溃疡的诊断与治疗

非甾体抗炎药 (ＮＳＡＩＤ)常伴有胃病 ,为常见的毒性药物之一。据美国 1996年统计每年因ＮＳＡＩＤ毒性住院者超过 10 0 0 0 0 ,死亡者 10 0 0 0～ 2 0 0 0 0 ,因ＮＳＡＩＤ毒性死亡率超过食管和胃其他疾病 ,也超过肝癌 ,其中ＮＳＡＩＤ最常见的并发症是消化性溃疡 (ＰＵＤ)。非甾体抗炎药物其作用机制相同。均通过抑制环氧化酶 (ｃｙ ｃｌｏｘｙｇｅｎａｓｅ,ＣＯＸ)的活性而抑制花生四烯酸最终生成前列腺素 (ＰＧ)。因此 ,ＮＳＡＩＤ能够减轻局部充血、肿胀、缓解疼痛 ,具有抗炎与镇痛作用。自 1899年水杨酸化学合成至今百年期间 ,ＮＳＡ…     

非甾体抗炎药相关性溃疡

本文简介了非甾体抗炎药相关性溃疡的发病机理、危险因素和临床特点,评述了该病的治疗和预防,对临床工作很有帮助。     

大黄治疗非甾体抗炎药相关消化性溃疡疗效观察

[目的]观察大黄对非甾体抗炎药(NSAIDs)相关消化性溃疡的疗效.[方法]将NSAIDs相关消化性溃疡96例,分为大黄治疗组(48例)和对照组(48例),对照组采用基础治疗,方法为口服奥美拉唑和清除幽门螺杆菌;大黄治疗组在对照组治疗的基础上加大黄粉口服.观察并比较2组的疗效.[结果]大黄治疗组痊愈19例(39.6％),好转26例(52.4％),无效3例(6.2％),总有效率93.8％;对照组痊愈16例(33.3％),好转22例(45.8％),无效10例(20.8％),总有效率79.2％;经x2检验,2组差异有统计学意义(P＜0.05).[结论]大黄粉与西药结合治疗NSAIDs相关消化性溃疡疗效更优.     

非甾体类抗炎药物与幽门螺杆菌感染对消化性溃疡协同致病作用研究

目的研究非甾体类抗炎药物(NSAIDs)与幽门螺杆菌(H.pylori)感染对消化性溃疡协同致病作用。方法回顾性分析我院80例消化性溃疡患者临床资料,其中胃溃疡40例(A组)、十二指肠溃疡40例(B组),另选消化内科其他就诊非消化性溃疡患者50例作为对照(C组),比较三组NSAIDs使用情况、H.pylori感染率,比较H.pylori(-)/NSAIDs(-)、H.pylori(+)/NSAIDs(+)、H.pylori(-)/NSAIDs(+)、H.pylori(+)/NSAIDs(-)时三组分布例数。结果A组NSAIDs使用率显著高于B、C组(P0.05),B组H.pylori阳性率显著高于A、C组(P0.05)。H.pylori(+)/NSAIDs(+)、H.pylori(-)/NSAIDs(+)时A组占55.6%、50.0%高于另外两组,而H.pylori(+)/NSAIDs(-)时B组占比较高。H.pylori(+)/NSAIDs(+)是消化性溃疡的危险因素,OR值为20.013。结论NSAIDs与H.pylori均为十二指肠溃疡的危险因素,但两者并无协同作用,以H.pylori感染风险更高,而两因素在胃溃疡患者中具有显著协同作用,需引起临床重视。     

非甾体抗炎药物和老年无痛消化性溃疡的组成

非甾体抗炎药物(NSAIDS)能严重损伤老年人尤其女性的胃和十二指肠粘膜。此药除有形成胃溃疡的特性外,还可缓解老年人消化性溃疡的症状,因此易延误诊断,导致预后不良。方法研究对象为普通医师(55％)、老年病学医师(33％)、外科医师和血液学医师(12％),对其进行全面消化系统内窥镜检查。插管前以表格形式记录患者出现的症状,内窥镜检查后详细询问病人用药史,特别是六周前服用NSAIDS的情况。为便于研究,将患者分为两个年龄组,一组为65～74岁,一组为≥75岁。     

幽门螺杆菌感染、服用非甾体抗炎药与消化性溃疡的关系

目的 研究消化性溃疡患者由于幽门螺杆菌（H.pylori）感染或服用非甾体抗炎药（NSAIDs）的发生率.方法 选取湖北省武汉市武昌医院2010年3月-2012年7月诊治的152例消化性溃疡患者,将其作为治疗组,同时选取同一时间段到消化科就诊的234例非消化性溃疡患者,将其作为对照组.结果 胃溃疡组感染H.pylori的几率是对照组的2.308倍,十二指肠溃疡组是对照组的8.186倍;胃溃疡组服用NSAIDs的几率是对照组的6.072倍,十二指肠溃疡组是对照组的2.823倍;胃溃疡组同时感染H.pylori和服用NSAIDs的几率是对照组的14.972倍,十二指肠溃疡组是对照组的28.873倍.结论 H.pylori感染同时服用了NSAIDs患者增加消化性溃疡的发生危险性,两种因素同时存在可以起协同作用,增加消化性溃疡的发生几率.     

非甾体类抗炎药与消化道肿瘤

非甾体类抗炎药(NSAID)对抑制实验动物的结肠癌、胃癌和食管癌有效,多数的流行病学调查也得到类似结论.消化道肿瘤组织中COX-2表达增加,因此COX抑制剂可能通过减少花生四烯酸代谢产物产生、减少免疫抑制性前列腺素的合成、抑制血管形成等途径抑制肿瘤.但NSAID也可以在完全缺乏COX活性的细胞中发挥抗增殖作用,因此激活对转录因子核因子кB的抑制以及抑制包括依赖CAMP的蛋白激酶在内的大量酶类等也可能是其抗肿瘤的作用方式.     

非甾体类抗炎药与胃肠道疾病

非甾休类抗炎药(NSAIDs)具有解热、镇痛、消炎、抗风湿及抑制血小板凝聚的作用,但这类药物的胃肠道副作用较为普遍,服药后会造成胃肠道粘膜的损伤,表现为粘膜的充血、出     

非甾体类抗炎药与胃肠道损伤

非甾体类抗炎药与胃肠道损伤韩伟韩英Ｓｕｂｊｅｃｔｈｅａｄｉｎｇｓａｎｔｉｉｎｆｌａｍｍａｔｏｒｙａｇｅｎｔｓ，ｎｏｎｓｔｅｒｏｉｄａｌ／ａｄｖｅｒｓｅｆｅｃｔｓ；ｇａｓｔｒｏｉｎｔｅｓｔｉｎａｌｄｉｓｅａｓｅｓ／ｃｈｅｍｉｃａｌｙｉｎｄｕｃｅｄ...     

Nonsteroidal anti-inflammatory drugs and peptic ulcer disease

Evidence has accumulated that nonsteroidal anti-inflammatory drugs (NSAIDs) cause clinically important gastroduodenal ulcers. The pathogenesis, which involves the impairment of mucosal resistance to injury in an acid-peptic environment, is multifactorial and controversial. Ulcers caused by NSAIDs can occur either in mucosa inflamed because of infection with Helicobacter pylori or in histologically normal mucosa. The use of these drugs has been linked to an unexpectedly high incidence of ulcer complications, and a history of peptic ulcer disease is common in such cases. Nonsteroidal anti-inflammatory drugs thus appear both to exacerbate an underlying peptic diathesis and to cause de novo ulcers. The association between the use of these drugs and ulcer complications is supported by ulcer prevalence data from cross-sectional studies, and by data from case-controlled and cohort studies, and from randomized, experimental trials. Drug-induced gastric ulcers have been prevented by misoprostol, but not by H2 blocker therapy. Several therapies have been reported to promote ulcer healing despite continued use of NSAIDs, but adequate controlled trials have not been done. Small gastric and duodenal ulcers readily heal, whereas larger gastric ulcers require vigorous and prolonged therapy. The relative efficacies of various therapies in preventing ulcers, healing ulcers, or preventing complications remain to be established.     

Nonsteroidal anti-inflammatory drug use and increased risk for peptic ulcer disease in elderly persons

OBJECTIVE: To evaluate the relative risk for peptic ulcer disease that is associated with the use of nonaspirin nonsteroidal anti-inflammatory drugs. DESIGN: Nested case-control study. SETTING: Tennessee Medicaid program. PARTICIPANTS: Medicaid enrollees 65 years of age or older were included in the study. The 1415 case patients had been hospitalized for confirmed peptic ulcer disease at some point from 1984 through 1986. The 7063 control persons represented a stratified random sample of other Medicaid enrollees. MEASUREMENTS AND MAIN RESULTS: The estimated relative risk for the development of peptic ulcer disease among current users of nonaspirin nonsteroidal anti-inflammatory drugs, compared with that among nonusers, was 4.1 (95% CI, 3.5 to 4.7). For current users, the risk increased with increasing dose, from a relative risk of 2.8 (CI, 1.8 to 4.3) for the lowest to a relative risk of 8.0 (CI, 4.4 to 14.8) for the highest dose category. The risk was greatest in the first month of use (relative risk, 7.2; CI, 4.9 to 10.5). If the association is fully causal, 29% of peptic ulcers in the study sample resulted from the use of these drugs, and the excess risk associated with such use was 17.4 hospitalizations for ulcer disease per 1000 person-years of exposure. CONCLUSIONS: These data support other findings indicating that a clinically significant risk for serious ulcer disease is associated with the use of nonaspirin nonsteroidal anti-inflammatory drugs. The data show that this risk increases with dose and recency of use and that use of these drugs may be responsible for a large proportion of peptic ulcer disease among elderly persons.     

Nonsteroidal anti-inflammatory drugs

Although the increased need for studies assessing the influence of age on the pharmacokinetics and pharmacodynamics of all drugs has been emphasized, relatively little is known about NSAIDs in the elderly. The pharmacokinetics of some NSAIDs have been examined in elderly subjects; unfortunately, recent data indicate that much of the earlier information may be incomplete or even misleading. Many studies report the disposition of only total NSAIDs. Since all of the NSAIDs are highly protein bound, it is the unbound, pharmacologically active, fraction that is most important. Few studies have quantified the pharmacokinetics of unbound NSAID in any age group, much less in elderly patients. Also, it is now apparent that studies of the propionic acid derivatives and other drugs with chiral centers must assess the disposition of the active S-enantiomer. Finally, studies of NSAIDs that form acylglucuronides are confounded by the reversion of these metabolites to active drug. Reduced renal elimination of these metabolites may be greater in elderly persons. Studies that account for these features of NSAIDs will provide necessary data for safe and effective use of NSAIDs in the elderly.     

Corticosteroid use and peptic ulcer disease: role of nonsteroidal anti-inflammatory drugs

OBJECTIVE: To estimate the relative risk for peptic ulcer disease that is associated with the use of oral corticosteroids. DESIGN: A nested case-control study. SETTING: Tennessee Medicaid program. PARTICIPANTS: The case patients (n = 1415) were hospitalized between 1984 and 1986 for gastric or duodenal ulcer or for upper gastrointestinal hemorrhage of unknown cause. The controls (n = 7063) were randomly selected from Medicaid enrollees not meeting the study criteria for inclusion as case patients. MEASUREMENTS AND MAIN RESULTS: The estimated relative risk for the development of peptic ulcer disease among current users of oral corticosteroids was 2.0 (95% CI, 1.3 to 3.0). However, the risk was increased only in those who concurrently received nonsteroidal anti-inflammatory drugs (NSAIDs); these persons had an estimated relative risk associated with current corticosteroid use of 4.4 (CI, 2.0 to 9.7). In contrast, the estimated relative risk for those corticosteroid users not receiving NSAIDs was 1.1 (CI, 0.5 to 2.1). Persons concurrently receiving corticosteroids and NSAIDs had a risk for peptic ulcer disease that was 15 times greater than that of nonusers of either drug. CONCLUSION: Discrepant findings among earlier studies regarding steroids and the risk for peptic ulcer disease could in part be due to differences in the use of NSAIDs among study participants. The high risk for peptic ulcer disease associated with combined use of NSAIDs and corticosteroids indicates the need to prescribe this drug combination cautiously.