RISK OF UPPER GASTROINTESTINAL-BLEEDING AND PERFORATION ASSOCIATED WITH INDIVIDUAL NONSTEROIDAL ANTIINFLAMMATORY DRUGS
RISK OF UPPER GASTROINTESTINAL-BLEEDING AND PERFORATION ASSOCIATED WITH INDIVIDUAL NONSTEROIDAL ANTIINFLAMMATORY DRUGS
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DOI：
10.1016/s0140-6736(94)91843-0
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发表时间：
1994-03-26
期刊：
影响因子：
168.9
通讯作者：
JICK, H
中科院分区：
文献类型：
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作者：
RODRIGUEZ, LAG;JICK, H
已知，接触非类固醇抗炎药(NSAIDs)会显著增加上消化道出血和穿孔(UGIB)的风险。我们进行了一项以人群为基础的回溯性病例对照研究，以评估不同个体非甾体抗炎药的风险差异，并调整了使用特点和其他独立的风险因素。研究样本包括1457例UGIB病例和10000名对照对象，这些病例是从英国全科医生的电脑记录中识别出来的。调整后的UGIB与当前NSAID使用相关的相对风险估计为4.7(95%可信区间3.8-5.7)。既往UGIB是UGIB最重要的预测因子(相对危险度13.5[10.3-17.7])。所有非甾体抗炎药加在一起，高剂量的风险比两次剂量大(7.0[5.2-9.6]vs2.6[1.8-3.8])。对个别非类固醇抗炎药相关风险的估计差异很大。在所研究的非甾体抗炎药中，氮丙酮(23.4[6.9-79.5])和吡罗昔康(18.0[8.2-39.6])的使用者发生UGIB的风险最高。所有其他有足够数据进行个体分析的非甾体抗炎药(布洛芬、萘普生、双氯芬酸、酮洛芬和吲哚美辛)的相对风险与整体非类固醇抗炎药的使用风险相似。对于有其他危险因素的患者，应谨慎使用非类固醇抗炎药，这些因素包括高龄、吸烟、消化性溃疡病史，以及口服皮质类固醇或抗凝剂的使用。
Exposure to non-steroidal anti-inflammatory drugs (NSAIDs) is known to increase substantially the risk of upper gastrointestinal bleeding and perforation (UGIB). We have carried out a population-based retrospective case-control study to assess the variation in risk associated with various individual NSAIDs, with adjustment for features of use and other independent risk factors.The study sample comprised 1457 cases of UGIB and 10 000 control subjects identified from general practitioners' computerised records in the UK. The adjusted estimate of relative risk of UGIB associated with current NSAID use was 4.7 (95% CI 3.8-5.7). Previous UGIB was the single most important predictor of UGIB (relative risk 13.5 [10.3-17.7]). For all NSAIDs together, the risk was greater for high doses than for tow doses (7.0 [5.2-9.6] vs 2.6 [1.8-3.8]). The estimates of risk associated with the individual NSAIDs varied widely. Users of azapropazone (23.4 [6.9-79.5]) and piroxicam (18.0 [8.2-39.6]) had the highest risk of UGIB among the NSAIDs studied. All the other NSAIDs with sufficient data for individual analysis (ibuprofen, naproxen, diclofenac, ketoprofen, and indomethacin) had relative risks similar to that for overall NSAID use.NSAIDS should be used cautiously in patients who have other risk factors for UGIB; these include advanced age, smoking, history of peptic ulcer, and use of oral corticosteroids or anticoagulants.