Inhibition of Aspirin-Induced Gastrointestinal Injury: Systematic Review and Network Meta-Analysis.
Inhibition of Aspirin-Induced Gastrointestinal Injury: Systematic Review and Network Meta-Analysis.
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DOI：
10.3389/fphar.2021.730681
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发表时间：
2021
影响因子：
5.6
通讯作者：
Zhu BC
中科院分区：
文献类型：
--
作者：
Zhang WT;Wang MR;Hua GD;Li QY;Wang XJ;Lang R;Weng WL;Xue CM;Zhu BC
背景资料：阿司匹林给药有可能导致胃肠道（GI）损伤的显著副作用，主要由胃酸刺激引起，特别是在长期使用者或患有原发性胃肠道疾病的使用者中。关于阿司匹林引起的胃肠道损伤的最佳治疗方法的争论仍在进行中。我们的目的是根据现有证据对阿司匹林引起的胃肠道损伤的不同治疗方法进行比较和排序。研究方法：我们检索了PubMed、EMBASE、科克伦图书馆（科克伦对照试验中心）和中文数据库，以查找从开始到2021年5月1日期间发表的关于阿司匹林诱导的胃肠道损伤的不同治疗方法的随机对照试验（RCT）。所有的直接和间接证据包括贝叶斯框架下的网络荟萃分析进行了评级。结果：共纳入10项随机对照试验，共503例受试者。证据的总体质量被评定为中等至高等。在预防胃肠道损伤方面，评价了11种不同治疗，包括奥美拉唑、兰索拉唑、雷贝拉唑、法莫替丁、香叶基香叶基丙酮、米索前列醇、枸橼酸铋雷尼替丁、辣椒、磷脂酰胆碱复合物、奥美拉唑+瑞巴派特和安慰剂。这表明奥美拉唑加瑞巴派特优于其他治疗，而香叶基香叶基丙酮和安慰剂是最少的治疗。结论：这是首次对阿司匹林引起的胃肠道损伤的不同治疗方法进行系统评价和网络荟萃分析。我们的研究表明，奥美拉唑联合瑞巴派特可能被认为是治疗阿司匹林引起的胃肠道损伤的最佳选择。未来更多的多中心、高质量、大样本随机对照试验将证实这些药物在治疗阿司匹林所致胃肠道损伤中的优势。
Background: Administration of aspirin has the potential for significant side effects of gastrointestinal (GI) injury mainly caused by gastric acid stimulation, especially in long-term users or users with original gastrointestinal diseases. The debate on the optimal treatment of aspirin-induced gastrointestinal injury is ongoing. We aimed to compare and rank the different treatments for aspirin-induced gastrointestinal injury based on current evidence. Methods: We searched PubMed, EMBASE, Cochrane Library (Cochrane Central Register of Controlled Trials), and Chinese databases for published randomized controlled trials (RCTs) of different treatments for aspirin-induced gastrointestinal injury from inception to 1 May 2021. All of the direct and indirect evidence included was rated by network meta-analysis under a Bayesian framework. Results: A total of 10 RCTs, which comprised 503 participants, were included in the analysis. The overall quality of evidence was rated as moderate to high. Eleven different treatments, including omeprazole, lansoprazole, rabeprazole, famotidine, geranylgeranylacetone, misoprostol, ranitidine bismuth citrate, chili, phosphatidylcholine complex, omeprazole plus rebamipide, and placebo, were evaluated in terms of preventing gastrointestinal injury. It was suggested that omeprazole plus rebamipide outperformed other treatments, whereas geranylgeranylacetone and placebo were among the least treatments. Conclusion: This is the first systematic review and network meta-analysis of different treatments for aspirin-induced gastrointestinal injury. Our study suggested that omeprazole plus rebamipide might be considered the best option to treat aspirin-induced gastrointestinal injury. More multicenter, high quality, large sample size randomized controlled trials will confirm the advantages of these medicines in the treatment of aspirin-induced gastrointestinal injury in the future.
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