风湿性疾病患者非甾体抗炎药胃病的临床分析

非甾体抗炎药（NSAIDs）因具有良好的抗炎、解热、镇痛作用而广泛应用于临床，但胃肠道不良反应较明显。目的：探讨风湿性疾病患者NSAIDs胃病的临床特征。方法：对服用NSAIDs至少2周的风湿性疾病患者行问卷调查和内镜检查。结果：共109例患者纳入研究。52例（47．7％）患者发生胃十二指肠黏膜损伤．其中黏膜糜烂36例（33．0％），溃疡13例（11．9％），糜烂和溃疡同时存在3例（2．8％）；29例（26．6％）患者病变位于胃部，11例（10．1％）位于十二指肠球部，12例（11．0％）为复合性损伤。各类风湿性疾病患者间的损伤发生率无明显差异。服用不同种类NSAIDs患者间的损伤发生率有显著差异（P〈0．05）。溃疡发生率随NSAIDs暴露时间的延长而上升（P〈0．05）。高龄（≥60岁）、幽门螺杆菌（H．pylori）感染、联合应用泼尼松可增加NSAIDs胃病发生的风险。结论：风湿性疾病人群中NSAIDs胃病的发生率较高，损伤多发生于胃部，以糜烂为主。传统NSAIDs、高龄（≥60岁）、且pylori感染和联合应用泼尼松是风湿性疾病患者发生NSAIDs胃病的危险因素。

Clinical Analysis of Nonsteroidal Anti-inflammatory Drugs Gastropathy in Patients with Rheumatic Disease

Background： Nonsteroidal anti-inflammatory drugs （NSAIDs） are widely used for their anti-inflammatory, fever relieving and analgesic effect, but they harbor the risk of gastrointestinal adverse reaction. Aims： To appraise the clinical characteristics of NSAIDs gastropathy in patients with rheumatic disease. Methods： Patients with rheumatic disease who had used NSAIDs for at least two weeks were assessed by means of questionnaire and endoscopy. Results： One hundred and nine patients were enrolled in this study. Gastrodnodenal lesions were found in 47.7% of patients （n=52）; among whom, 33.0% （n=36） had erosions, 11.9% （n=13） had ulcers, and 2.8% （n=3） had both erosions and ulcers; 26.6% （n=29） had their lesions located in the stomach, 10.1% （n=11） in the duodenal bulb, and 11.0% （n=12） were complex lesions. Relevance was found between the prevalence of gastroduodenal lesions and type of NSAIDs （P〈0.05）, but not the type of rheumatic disease. The prevalence of ulcers increased with the prolonged duration of exposure to NSAIDs （P〈0.05）. Age ≥ 60 years, Helicobacter pylori （H. pylori） infection, and concomitant prednisone use could increase the risk of developing NSAIDs gastropathy. Conclusions： Prevalence of NSAIDs gastropathy is high in patients with rheumatic disease. It mostly locates in the stomach with erosion as the major damage. Use of conventional NSAIDs, age ≥ 60 years, 11. pylori infection, and concomitant prednisone use are risk factors for NSAIDs gastropathy in patients with rheumatic disease.