非甾体类抗炎药相关性胃十二指肠黏膜损害临床调查分析

Clinical survey on gastroduodenal damages induced by nonsteroidal anti-inflammatory drugs

目的探讨非甾体类抗炎药（NSAID）相关性胃十二指肠黏膜损害的发生情况及其危险因素。方法收集心血管科与风湿免疫科门诊中184例长期服用NSAID的患者作为研究对象。记录患者的一般资料，对患者的消化不良症状进行评分，胃镜下行黏膜损伤评分，留取标本行幽门螺杆菌（Hp）检测，并行统计分析。结果在184例长期服用NSAID患者中共发现消化性溃疡63例（34．2％），其中胃溃疡22例、十二指肠溃疡34例、复合性溃疡7例。在其余121例无溃疡患者中，57例胃黏膜存在3处或3处以上糜烂灶。Logistic多因素回归分析发现，Hp感染是长期服用NSAID人群发生消化性溃疡的重要危险因素（OR=13．86，95％CI：6．53～29．43）。低剂量阿司匹林与其他NSAID导致胃十二指肠黏膜损伤的发生率相似（OR=0．45，95％CI：0．16～1．28）。结论长期服用NSAID者胃十二指肠黏膜易受损，Hp感染是重要的危险因素。低剂量阿司匹林致胃肠道损伤的发生率与其他NSAID相似。

Objective To investigate the prevalence and the risk factors of gastroduodenal damages induced by nonsteroidal anti-inflammatory drugs （NSAIDs）. Methods One hundred and eightyffour patients who were prescribed NSAIDs for long time in rheumatology and cardiovascular clinics were enrolled. Clinical data such as age, sex, medication history and body mass index were recorded. The lesions were estimated by endoscopy and the specimens were tested for Helicobacter pylori （H. pylori） infection. Results Peptic ulcer was found in 63 （34. 24%） patients including gastric ulcer in 22, duodenal ulcer in 34 and compound ulcer in 7. The endoscopic examination showed that 57 out of 121 patients without peptic ulcer had ≥3 erosive lesions. Logistic regression analysis revealed that H. pylori infection was important risk factor that induced the peptic ulcer in those who were taking NSAIDs for long time （OR = 13. 86, 95% CI： 6. 53 -29. 43）. The incidence of gastroduodenal damage was similar in patients taking NSAIDs and low dose aspirin （OR =0.45,95% CI：0. 16-1.28）. Conclusions NSAIDs may cause gastroduodenal damages in long-term users and H. pylori infection was an important risk factor. The effect of low dose aspirin on gastroduodenal damages is as same as NSAIDs.