非甾体类药物所致的上消化道溃疡的预防-Meta分析

目的 评价前列腺素衍生物、质子泵抑制剂、H2受体拮抗剂在预防NSAIDs导致的上消化道毒性方面的效果。方法 检索策略：根据Conchrane图书馆的标准，检索电子数据库MEDLINE以及中国生物医学文献数据库(CBMdisc)，并查询近3年国内外重要消化病学学术会议的论文集。选择标准：使用PA、PPI、H2RA预防服用NSAIDs导致的上消化道溃疡的随机对照试验。收集到的分散型数据使用RevMan4．1软件进行统计，并同时统计它们的异质性。结果米索前列醇与安慰剂相比，能降低胃溃疡和十二指肠溃疡的相对危险分别为76％和62％。米索前列醇800ug/d对胃溃疡和十二指肠溃疡减少的相对危险分别为87％和87％。低剂量米索前列醇降低胃溃疡和十二指肠溃疡的相对危险分别为70％和43％。PPI减少胃溃疡和十二指肠溃疡的相对危险分别为64％和81％。半量PPI减少胃溃疡和十二指肠溃疡的相对危险分别为71％和81％。标准剂量H2RA与安慰剂比较，减少十二指肠溃疡的相对危险为68％，但在预防发生胃溃疡发生的危险方面差异无统计学意义(P=-0．18)。双倍剂量H2RA与安慰剂比较，减少胃溃疡和十二指肠溃疡的相对危险分别为54％和63％0结论800ug／d和低剂量的米索前列醇都能够预防NSAIDs所致的消化性溃疡。标准剂量的H2RA不应该用于预防NSAIDs的毒性作用。双倍剂量的H2RA和半量的PPI在预防内镜下十二指肠溃疡和胃溃疡方面都有效。

The prevention of NSAIDs-induced gastroduodenal ulcers-Meta analysis

Objective Review the effectiveness of common interventions, such as prostaglandin analogues (PA), H2-receptor antagonists (H2RA) and proton pump inhibitors (PPI), for the prevention of NSAIDS-induced upper GI toxicity. Methods Search Strategy: A literature search was conducted in electronic databases, including MEDLINE from 1966 to June 2004 and CBMdisc from 1979 to 2004. Recent conference proceedings, which are 3 years prior to 2004,have been reviewed. Selection Criteria: Randomized controlled trials (RCTs) of PA,H2RA or PPI for the prevention of chronic NSAIDS-induced upper GI toxicity are included. Dichotomous data was pooled using RevMan 4.1. Heterogeneity was evaluated. Results Misoprostol compared with placebo can significantly decrease the RR of gastric ulcer (GU) 76%,whilst decreasing the RR of duodenal ulcer (DU) 62%. Misoprostol 800 ug/d can decrease the RR of GU and DU 87% and 87% separately. Low dose Misoprostol group can decrease the RR of GU and DU 70% and 43% separately. PPI compared with placebo, it decreases the RR of GU and DU is 64% and 81% separately. Half dose PPI can decrease the RR of GU and DU 71% and 81% separately. Standard dose H2RA comparing with placebo, it can decrease the RR of DU 68%, but it is not statistically significant difference of GU. Double dose H2RA can decrease the RR of GU and DU 54% and 63% separately. Conclusion Both 800 ug/d and low dose of Misoprostol can prevent the NSAIDS-induced ulcer. Standard dose H2RA can not be used to prevent the NSAIDS-induced ulcer. Double dose H2RA and half dose PPI can prevent the NSAIDS-induced ulcer and easily be accepted.