Steroids and risk of upper gastrointestinal complications
Steroids and risk of upper gastrointestinal complications
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DOI：
10.1093/aje/153.11.1089
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发表时间：
2001-06-01
影响因子：
5
通讯作者：
Rodríguez, LAG
中科院分区：
文献类型：
--
作者：
Hernández-Díaz, S;Rodríguez, LAG
大多数抗炎药与上消化道并发症的增加有关。然而，关于类固醇的文献比关于非类固醇抗炎药（NSAID）的文献更为有限。为了估计与单独使用类固醇和联合使用类固醇相关的上消化道并发症的风险，对英国全科医学研究数据库进行了巢式病例对照分析。作者在 1993 年至 1998 年间确定了 2,105 例上消化道并发症和 11,500 名对照者。与当前使用口服类固醇相关的调整后比值比，总体上消化道并发症为 1.8（95% 置信区间 (CI)：1.3, 2.4），胃部并发症为 2.4（95% CI：1.7, 3.4），胃部并发症为 1.2（95% CI：1.2）。 0.8, 1.9) 十二指肠损伤。类固醇与出血（比值比 (OR) = 1.8；95% CI：1.3，2.4）和穿孔（OR = 1.6；95% CI：0.9，3.1）相似。与不使用类固醇相比，同时使用低、中和高 NSAID 剂量的类固醇分别产生 4.0 (95% CI: 1.3, 12.0) 和 12.7 (95% CI: 8.2, 26.1) 的比值比。只要有可能，应以单一疗法和最低有效剂量给予抗炎药物，以降低上消化道并发症的风险。
Most antiinflammatory drugs have been associated with an increase in upper gastrointestinal complications. However, the literature on steroids is more limited than that on nonsteroidal antiinflammatory drugs (NSAIDs). To estimate the risk of upper gastrointestinal complications associated with use of steroids alone and in combination, a nested case-control analysis was conducted on the General Practice Research Database from the United Kingdom. The authors identified 2,105 cases of upper gastrointestinal complications and 11,500 controls between 1993 and 1998. The adjusted odds ratios associated with current use of oral steroids were 1.8 (95% confidence interval (CI): 1.3, 2.4) for upper gastrointestinal complications overall and 2.4 (95% CI: 1.7, 3.4) for gastric and 1.2 (95% CI: 0.8, 1.9) for duodenal damage. Steroids were similarly associated with bleeding (odds ratio (OR) = 1.8; 95% CI: 1.3, 2.4) and perforations (OR = 1.6; 95% CI: 0.9, 3.1). Simultaneous use of steroids with low-medium and high NSAID doses, respectively, produced odds ratios of 4.0 (95% CI: 1.3, 12.0) and 12.7 (95% CI: 8.2, 26.1), compared with users of none. Whenever possible, antiinflammatory drugs should be given in monotherapy and at the lowest effective dose in order to reduce the risk of upper gastrointestinal complications.