非类固醇类抗炎药相关消化性溃疡的预防和治疗

非类固醇类抗炎药(NSAIDs)是消化性溃疡(PU)的主要病因.NSAIDs相关PU的发病率和并发症发生率较高.在应用NSAIDs时,可选用胃肠毒性较低的非选择性NSAIDs,并与质子泵抑制剂或米索前列醇合用;或单用选择性环氧合酶-2抑制剂(高危患者考虑加用质子泵抑制剂),可以降低NSAIDs相关PU的发病率.治疗NSAIDs相关PU最有效的方法是停用NSAIDs,然后应用组胺H2受体拮抗剂或质子泵抑制剂,以促进溃疡愈合;不能停用NSAIDs的患者,应同时应用质子泵抑制剂,以缓解症状、促进溃疡愈合和预防并发症发生.选择性环氧合酶-2抑制剂是否增加心、脑血管血栓形成的危险,有待进一步研究.新一代安全性较高的NSAIDs正在研制中.

Prevention and therapy of non-steroidal anti-inflammatory drug-related peptic ulcer

The use of non-steroidal anti-inflammatory drugs (NSAIDs) is the main cause of peptic ulcer (PU). There are high incidences and complication rates of NSAID-related PU. We can choose non-selective NSAIDs with less gastrointestinal toxicity combined with proton pump inhibitors (PPIs) or misoprostol to reduce the incidence of NSAID-related PU. In single choice of selective COX-2 inhibitors, high-risk patients may consider adding PPI to reduce the incidence of NSAID-related PU. The most effective therapy for patients with NSAID-related PU is the discontinuation of NSAIDs, then H2-receptor antagonists (H2RAs) or PPIs are administered to accelerate healing of ulcers. If NSAIDs must be continued, PPIs should be administered at the same time in order to relieve clinical symptoms, accelerate healing of ulcers and prevent complications. Further studies will be required to determine if the selective COX-2 inhibitors increase the risk of cardiovascular and cerebrovascular thrombotic events. A new generation of more safer NSAIDs is under development.