IS THERE AN OPTIMAL DEGREE OF ACID SUPPRESSION FOR HEALING OF DUODENAL-ULCERS - A MODEL OF THE RELATIONSHIP BETWEEN ULCER HEALING AND ACID SUPPRESSION
IS THERE AN OPTIMAL DEGREE OF ACID SUPPRESSION FOR HEALING OF DUODENAL-ULCERS - A MODEL OF THE RELATIONSHIP BETWEEN ULCER HEALING AND ACID SUPPRESSION
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DOI：
10.1016/0016-5085(90)91015-x
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发表时间：
1990-08-01
期刊：
影响因子：
29.4
通讯作者：
HUNT, RH
中科院分区：
文献类型：
--
作者：
BURGET, DW;CHIVERTON, SG;HUNT, RH
消化性溃疡愈合所需的胃酸抑制的最佳程度和持续时间尚未确定。虽然现在已经有了非常有效的酸分泌抑制剂，但还没有显示出需要这种程度的抑制，而且由于明显的酸抑制，有可能产生不利影响。因此，已经构建了一个模型，该模型定义了十二指肠溃疡愈合和抗分泌治疗之间的关系。酸抑制数据直接从研究人员那里获得，作为24小时酸分泌研究的原始数据。来自7名研究人员的21项实验提供了使用19种不同治疗方案的490项24小时研究。愈合数据来自对已发表的十二指肠溃疡愈合临床试验的荟萃分析。总共在14,208名患者中发表了144项试验，提供了19种药物方案的几个内窥镜终点的愈合数据，其中提供了酸度数据。采用加权最小二乘多项式回归分析，确定对十二指肠溃疡愈合影响最大的抗分泌治疗参数，并确定响应面的形状。治愈率与抑酸程度、抑酸时间和治疗时间呈高度显著相关(r=0.9814)。表达这一关系的轮廓形状表明，随着抑制时间的延长和胃液pH值的增加，愈合率增加。然而，将pH值提高到3.0以上的抑制并未发现进一步促进溃疡愈合。结论：对于十二指肠溃疡的愈合，较长时间的抗分泌作用和/或较长的治疗时间比药效更重要。
The optimal degree and duration of suppression of gastric acidity required for the healing of peptic ulcers has never been established. Although very potent inhibitors of acid secretion are now available, the need for this degree of suppression has not been shown, and there is a possibility of adverse effects because of pronounced acid inhibition. Therefore, a model has been constructed that defines the relationship between duodenal ulcer healing and antisecretory therapy. Acid suppression data were obtained directly from investigators as raw data from 24-hour studies of acid secretion. Twenty-one experiments from seven investigators provided 490 24-hour studies using 19 different treatment regimens. Healing data were collected from a metaanalysis of published clinical trials of duodenal ulcer healing. A total of 144 published trials in 14,208 patients provided healing data at several endoscopic endpoints for the 19 drug regimens for which acidity data were provided. Weighted least-squares polynomial regression analysis was used to define those parameters of antisecretory therapy that contributed most to duodenal ulcer healing and to define the shape of the response surface. A highly significant correlation (r = 0.9814) was found between healing and the degree of acid suppression, the duration of acid suppression, and the length of therapy. The shape of the contour expressing this relationship shows that healing increases as the duration of suppression increases and as gastric pH increases. However, suppression that increased pH beyond 3.0 was not found to increase ulcer healing further. It is concluded that a longer duration of antisecretory effect and/or a longer duration of therapy are of greater importance than potency for duodenal ulcer healing.