CAJ | 학술논문

目的评价长期服用非甾体类抗炎药(NSAID)引发胃黏膜的损伤情况,并探讨替普瑞酮对患者胃黏膜的保护作用.方法收集长期服用NSAID且幽门螺杆菌(Hp)阴性患者108例,进行上消化道症状及胃镜评估.其中无溃疡患者92例,采用前瞻性随机对照研究,按是否服用替普瑞酮随机分为干预组(45例)与非干预组(47例),随访3个月后再次行上消化道症状及胃镜评估.在入选时及随访3个月后分别留取胃黏膜标本比较胃黏液层密度和环氧合酶(COX)表达水平.结果在108例患者中发现消化性溃疡16例(14.8%),48例(44.4%)患者在胃镜下可观察到3处及以上黏膜糜烂灶.随访3个月后,替普瑞酮十预组患者胃黏膜损伤明显轻于非干预组(z=-4.96,P=0.000);胃黏液合成与分泌多于非干预组[阳性率66.7%(30/45)比13.3%(6/45),P=0.000];COX-1表达亦多于非干预组[31.1%(14/45)比6.7%(3/45),P=0.003];而COX-2表达则无变化[28.9%(13/45)比31.1%(14/45),P=0.82].结论长期服用NSAID可致明显胃黏膜损伤;同时服用替普瑞酮可以降低胃黏膜损伤的发生,这可能与其促进黏液合成分泌和增加黏膜内COX-1表达有关.
목적 평개장기복용비치체류항염약(NSAID)인발위점막적손상정황,병탐토체보서동대환자위점막적보호작용.방법 수집장기복용NSAID차유문라간균(Hp)음성환자108례,진행상소화도증상급위경평고.기중무궤양환자92례,채용전첨성수궤대조연구,안시부복용체보서동수궤분위간예조(45례)여비간예조(47례),수방3개월후재차행상소화도증상급위경평고.재입선시급수방3개월후분별류취위점막표본비교위점액층밀도화배양합매(COX)표체수평.결과 재108례환자중발현소화성궤양16례(14.8%),48례(44.4%)환자재위경하가관찰도3처급이상점막미란조.수방3개월후,체보서동십예조환자위점막손상명현경우비간예조(z=-4.96,P=0.000);위점액합성여분비다우비간예조[양성솔66.7%(30/45)비13.3%(6/45),P=0.000];COX-1표체역다우비간예조[31.1%(14/45)비6.7%(3/45),P=0.003];이COX-2표체칙무변화[28.9%(13/45)비31.1%(14/45),P=0.82].결론 장기복용NSAID가치명현위점막손상;동시복용체보서동가이강저위점막손상적발생,저가능여기촉진점액합성분비화증가점막내COX-1표체유관.
Objective To evaluate the side effects of non-steroidal anti-inflammatory drugs (NSAID)on gastric mucosa and to study the preventive effects of teprenone in patients.Methods A total of 108 patients taking NSAID for more than 3 months with no infection of Helicobacter pylori(Hp)were recruited. All patients were Bcrleened by endoscopy and their upper gastrointestinal symptores were evaluated. Then,after excluding 16 patients with ulcer8,92 patients were randomly divided into intervention group with teprenone and control group.After follow-up for 3 months,the patients were re-screened by endoscopy and their upper gastrointestinal symptoms re-evaluated.Specimens of gastric mne06a were studied by PAS staining,and cyclooxygenase(COX)level were evaluated by immunohistuchemical technique.Results Among the patients taking NSAIDs,erosion occurred in 48(44.4%)patients while 16(14.8%)were found with peptic ulcers.The damages improved significantly(Z=-4.96,P=0.000)in the intervention group with teprenone(n=45)as compared with the control group(n=47)after follow-up for 3 months.Both COX-1 Jevel[31.1%(14/45)vs 6.7%(3/45),P=0.003] and mucous thickness [66.7%(30/45)vs 13.3%(6/45),P=0.000]also increased in the intervention group as compared with the control group.No significant difierenee was found in COX-2 level between these two groups[28.9%(13/45)vs 31.1%(14/45),P=0.82].Conclusion Long-term use of NSAID caused severe damages to gastroduodenal mucosa;teprenone improved NSAID-related gastric side effects and increased COX-1 level and mucous thickness.