The impact of low-dose aspirin on endoscopic gastric and duodenal ulcer rates in users of a non-selective non-steroidal anti-inflammatory drug or a cyclo-oxygenase-2-selective inhibitor
The impact of low-dose aspirin on endoscopic gastric and duodenal ulcer rates in users of a non-selective non-steroidal anti-inflammatory drug or a cyclo-oxygenase-2-selective inhibitor
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DOI：
10.1111/j.1365-2036.2006.02912.x
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发表时间：
2006-05-15
影响因子：
7.6
通讯作者：
Dodge, WE
中科院分区：
文献类型：
--
作者：
Goldstein, JL;Lowry, SC;Dodge, WE
低剂量阿司匹林对环氧化酶-2选择性抑制剂或非选择性非甾体抗炎药使用者胃镜溃疡发生率的影响仍存在争议。前瞻性比较健康受试者服用低剂量阿司匹林加塞来昔布或萘普生的内窥镜溃疡发生率。在这项双盲、安慰剂对照、为期一周的研究中，受试者（50-75岁）随机接受阿司匹林325 mg / d +塞来昔布200 mg / d，萘普生500 mg / d或安慰剂。基线和研究结束时进行内窥镜检查。主要终点是一个或多个胃和十二指肠溃疡的发生率。塞来昔布/阿司匹林组的胃和十二指肠溃疡发生率（19%）低于萘普生/阿司匹林组（27%;RR: 0.63, 95% CI: 0.44-0.92）。萘普生/阿司匹林组和塞来昔布/阿司匹林组与安慰剂/阿司匹林组相比，胃溃疡和十二指肠溃疡发生率均较高（8%;RR: 3.7, 95% CI: 1.8-7.6; RR: 2.6, 95% CI: 1.2-5.8）。用塞来昔布/阿司匹林治疗的患者比用萘普生/阿司匹林治疗的患者更少观察到内镜溃疡。然而，塞来昔布/阿司匹林与胃和十二指肠溃疡的发生率明显高于阿司匹林单独使用。需要进一步的研究来确定这些发现在阿司匹林使用者中的普遍性，并确定适当的策略来减少易感患者的风险。
The effect of low-dose aspirin on endoscopic ulcer incidence in cyclo-oxygenase-2-selective inhibitor or non-selective non-steroidal anti-inflammatory drug users remains controversial.To compare prospectively the incidence of endoscopic ulcers in healthy subjects receiving low-dose aspirin plus celecoxib or naproxen.In this double-blind, placebo-controlled, 1-week study, subjects (50-75 years) were randomized to receive aspirin 325 mg o.d. plus either celecoxib 200 mg o.d., naproxen 500 mg b.d., or placebo. Baseline and end of study endoscopies were performed. The primary end point was incidence of one or more gastric and duodenal ulcers.A lower incidence of gastric and duodenal ulcers was seen in celecoxib/aspirin-treated subjects (19%) vs. naproxen/aspirin (27%; RR: 0.63, 95% CI: 0.44-0.92). Both naproxen/aspirin and celecoxib/aspirin groups demonstrated a higher incidence of gastric and duodenal ulcers vs. placebo/aspirin (8%; RR: 3.7, 95% CI: 1.8-7.6 and RR: 2.6, 95% CI: 1.2-5.8, respectively).Fewer endoscopic ulcers were observed in patients treated with celecoxib/aspirin vs. naproxen/aspirin. However, celecoxib/aspirin was associated with a significantly higher incidence of gastric and duodenal ulcers than aspirin alone. Further studies are required to determine the generalizability of these findings in the aspirin users and to determine the appropriate strategy to minimize risk in susceptible patients.