Individual nonsteroidal antiinflammatory drugs and other risk factors for upper gastrointestinal bleeding and perforation
Individual nonsteroidal antiinflammatory drugs and other risk factors for upper gastrointestinal bleeding and perforation
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DOI：
10.1097/00001648-199701000-00003
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发表时间：
1997-01-01
期刊：
影响因子：
5.4
通讯作者：
Raiford, DS
中科院分区：
文献类型：
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作者：
Gutthann, SP;Rodriguez, LAG;Raiford, DS
我们对1,377例上消化道出血或穿孔(UGIB)患者和10,000名对照组进行了嵌套式病例对照研究，以评估个体非类固醇抗炎药(NSAID)、使用特点和其他危险因素与这些疾病的关系。年龄是UGIB的最大危险因素。男性、复杂消化性溃疡病史和目前使用类固醇也是UGIB的危险因素。调整后的优势比(OR)为4.3[95%可信区间(CI)=3.7-5.0]。对于死亡病例以及胃、十二指肠、幽门前和多个病变部位，目前使用非甾体抗炎药的OR值相似，但穿孔的OR值显著增加(OR=16.9；95%CI=9.1-31.5)。80岁或80岁以上的女性使用非甾体抗炎药的影响最大。目前使用多种非甾体抗炎药的人和最近更换药物的人的OR值分别为9.0和6.2。布洛芬的OR最低，异氟尼柳的OR最高。每日低、中、高剂量NSAIDORS分别为2.9、4.2、5.8。这一趋势在新用户、短期用户和长期用户中都存在。同时使用多种非甾体抗炎药以及大剂量单独使用单一非甾体抗炎药会极大地增加复杂性消化性溃疡疾病的风险。
We conducted a nested case-control study of 1,377 cases of upper gastrointestinal bleeding or perforation (UGIB) and 10,000 controls to evaluate the association of individual nonsteroidal antiinflammatory drugs (NSAIDs), utilization characteristics, and other risk factors for these conditions. Age was the strongest risk factor for UGIB. Male gender, history of complicated peptic ulcer disease, and current use of steroids were also risk factors for UGIB. The adjusted odds ratio (OR) for current NSAID use was 4.3 [95% confidence interval (CI) = 3.7-5.0]. The ORs for current NSAID use were similar for fatal cases and for the gastric, duodenal, prepyloric, and multiple sites of lesion, but the OR was substantially increased for perforations (OR = 16.9; 95% CI = 9.1-31.5). Women age 80 years or older experienced the greatest effect of NSAID use. Current users of multiple NSAIDs and recent switchers showed ORs of 9.0 and 6.2, respectively. Ibuprofen showed the lowest OR and diflunisal, the highest. ORs for low, medium, and high NSAID daily dose were 2.9, 4.2, and 5.8, respectively. This trend was present among new, short-term, and long-term users. Simultaneous use of multiple NSAIDs as well as use of a single individual NSAID at high doses greatly increases the risk of complicated peptic ulcer disease.