RISKS OF BLEEDING PEPTIC-ULCER ASSOCIATED WITH INDIVIDUAL NONSTEROIDAL ANTIINFLAMMATORY DRUGS
RISKS OF BLEEDING PEPTIC-ULCER ASSOCIATED WITH INDIVIDUAL NONSTEROIDAL ANTIINFLAMMATORY DRUGS
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DOI：
10.1016/s0140-6736(94)90185-6
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发表时间：
1994-04-30
期刊：
影响因子：
168.9
通讯作者：
COLINJONES, DG
中科院分区：
文献类型：
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作者：
LANGMAN, MJS;WEIL, J;COLINJONES, DG
使用非类固醇抗炎药(NSAIDs)治疗会增加消化性溃疡并发症的风险，但目前尚不清楚某些药物是否比其他药物更有可能导致此类并发症。我们比较了五个大城市住院的1144名60岁及以上消化性溃疡出血患者以及1126名医院对照组和989名年龄和性别匹配的社区对照组以前使用NSAIDs的情况。消化性溃疡出血与入院前3个月内使用任何类型的非阿司匹林非类固醇抗炎药密切相关(411例，351名对照；优势比4.5[95%CI 3.6至5.6])。消化性溃疡出血的优势比最低的是布洛芬(2.0[1.4-2.8])和双氯芬酸(4.2[2.6-6.8])，其次是消炎痛、萘普生和吡罗昔康(11.3[6.3-20.3]，9.1[5.5-15.1]和13.7[7.1-26.3])。阿扎丙酮和酮洛芬的风险最高(31.5[10.3-96.9]和23.7[7.6-74.2])。对于所有药物，风险也随着药物剂量(低剂量2.5[1.7-3.8]、中等剂量4.5[3.3-6.0]和高8.6[5.8-12.6])的增加而增加。适当的临床策略可以防止消化性溃疡出血的多次发作：非甾体抗炎药应该只用于对其他止痛药无效的患者；应该使用尽可能低的剂量；应该选择毒性最小的非甾体抗炎药。
Treatment with non-steroidal anti-inflammatory drugs (NSAIDs) is associated with an increased risk of peptic ulcer complications, but it is not clear whether some drugs are more likely than others to cause such complications.We compared previous use of NSAIDs in 1144 patients aged 60 and older admitted to hospitals in five large cities with peptic ulcer bleeding and in 1126 hospital controls and 989 community controls matched for age and sex. Peptic ulcer bleeding was strongly associated with use of non-aspirin NSAIDs of any type during the 3 months before admission (411 cases, 351 controls; odds ratio 4.5 [95% Cl 3.6 to 5.6]). The odds ratios for peptic ulcer bleeding were lowest for ibuprofen (2.0 [1.4-2.8]) and diclofenac (4.2 [2.6-6.8]), and intermediate for indomethacin, naproxen, and piroxicam (11.3 [6.3-20.3], 9.1 [5.5-15.1], and 13.7 [7.1-26.3]). Azapropazone and ketoprofen carried the highest risks (31.5 [10.3-96.9] and 23.7 [7.6-74.2]). Risks also increased with drug dose (low dose 2.5 [1.7-3.8], intermediate 4.5 [3.3-6.0], and high 8.6 [5.8-12.6]) for all drugs combined.Appropriate clinical strategies could prevent many episodes of peptic ulcer bleeding: NSAIDs should be used only in patients who do not respond to other analgesics; the lowest possible doses should be used; and the least toxic NSAIDs should be selected.