CAJ | 학술논문

目的评价质子泵抑制剂(PPI)预防非甾体类抗炎药(NSAID)相关性溃疡复发的临床疗效和安全性.方法检索中国生物医学文献数据库、Medline等,纳入PPI预防NSAID相关性溃疡复发的所有临床随机对照试验.采用Cochrane协作网提供的RevMan 4.2软件进行荟萃分析.结果 10项随机临床试验共3361例患者纳入研究.荟萃分析结果显示,PPI显著降低NSAID相关性溃疡的复发率(8.7%),与对照组比较差异有统计学意义(17.2%,P=0.03).其中,接受埃索美拉唑治疗和兰索拉唑治疗的患者溃疡复发率明显减低(4.4%和18.0%),与对照组比较差异均有统计学意义(14.7%和28.7%,P值分别为0.01和0.05),而奥美拉唑组与对照组相比并无明显优势(P=0.16).不同剂量PPI比较,埃索美拉唑20 mg/d、40 mg/d和兰索拉唑15 mg/d组NSAID溃疡的复发率分别为4.4%、4.3%和19.7%.将NSAID分层分析发现,PPI可有效预防非选择性NSAID溃疡的复发(P=0.009),但对选择性环氧合酶-2抑制剂无明显优势(P=0.58).未发现PPI治疗组和对照组发生明显的药物不良反应.结论以埃索美拉唑为主的PPI在不停用NSAID的情况下,能有效预防已经发生的NSAID相关性溃疡的复发,疗效可靠、耐受性好.
목적 평개질자빙억제제(PPI)예방비치체류항염약(NSAID)상관성궤양복발적림상료효화안전성.방법 검색중국생물의학문헌수거고、Medline등,납입PPI예방NSAID상관성궤양복발적소유림상수궤대조시험.채용Cochrane협작망제공적RevMan 4.2연건진행회췌분석.결과 10항수궤림상시험공3361례환자납입연구.회췌분석결과현시,PPI현저강저NSAID상관성궤양적복발솔(8.7%),여대조조비교차이유통계학의의(17.2%,P=0.03).기중,접수애색미랍서치료화란색랍서치료적환자궤양복발솔명현감저(4.4%화18.0%),여대조조비교차이균유통계학의의(14.7%화28.7%,P치분별위0.01화0.05),이오미랍서조여대조조상비병무명현우세(P=0.16).불동제량PPI비교,애색미랍서20 mg/d、40 mg/d화란색랍서15 mg/d조NSAID궤양적복발솔분별위4.4%、4.3%화19.7%.장NSAID분층분석발현,PPI가유효예방비선택성NSAID궤양적복발(P=0.009),단대선택성배양합매-2억제제무명현우세(P=0.58).미발현PPI치료조화대조조발생명현적약물불량반응.결론 이애색미랍서위주적PPI재불정용NSAID적정황하,능유효예방이경발생적NSAID상관성궤양적복발,료효가고、내수성호.
Objective To assess the clinical efficacy and safety of proton pump inhibitors (PPI)for preventing recurrence of non-steroidal anti-inflammatory drugs (NSAIDs)-indueed upper gastrointestinal ulcers using meta-analysis. Methods Mono- or multicenter randomized controlled clinical trials related to NSAIDs-indueed ulcers were retrieved from database of China Biological Medicine and Medline from 1966 to 2007. The data were analyzed by RevMan 4. 2 software using random or fixed effects model. Results Ten randomized controlled trials including 3361 patients were included, The recta-analysis revealed that PPI treatment significantly reduced the recurrent rate of NSAIDs-associated ulcers (8. 7%) in comparison with controls (17. 2%, P = 0. 03). Those who received esomeprazole (4. 4%) or lansoprazole (18. 0%) had a low recurrence of peptic ulcers compared with controls (14.7% or 28.7%, P value= 0.01 or 0.05). But there was no significant differencebetween omeprazole and controls (P= 0. 16). The recurrence of NSAIDs-associated ulcers in patients treated with esomeprazole 20 mg or 40 mg and tansoprazole 15 mg were 4.4%, 4.3% and 19.7 % respectively. The stratify analysis showed that PPI therapy could effectively reduce recurrentce of non-selective NSAIDs-induced ulcer (P= 0. 009), but failed to selective cyclooxygenase (COX)-2 inhibitor induced ulcer. No severe adverse reactions were found in PPI groups. Conclusion PPI is effective and safe in prevention of NSAIDs-related ulcers without discontinuation of NSAIDs.