雷贝拉唑预防心血管病患者阿司匹林引起的消化性溃疡

Rabeprazole for preventing aspirin-related peptic ulcer in patients with cardiovascular diseases

目的探讨雷贝拉唑对小剂量阿司匹林引起消化性溃疡的预防作用。方法纳入2010年6月～2012年2月,患心血管病需抗血小板治疗的患者166例,随机分为对照组(n=83)和观察组(n=83)。对照组单用阿司匹林(100mg,qd);观察组在服用等剂量阿司匹林肠溶片同时服用雷贝拉唑钠肠溶胶囊(20mg,qd)。对比两组患者出现上腹不适、上腹痛、烧心、反酸等消化道不适症状,同时比较两组胃镜下黏膜表现变化和呕血、黑便等消化道出血临床症状。结果对照组和观察组分别出现消化道症状37例(44.6%)和4例(4.8%),对照组胃肠黏膜损伤患者29例(34.9%),其中消化性溃疡12例(14.5%),观察组发生胃黏膜损伤患者仅6例(7.2%),其中消化性溃疡1例(1.2%),观察组的消化道症状发生率、胃肠粘膜损伤率以及消化性溃疡发生率均显著低于对照组,差异均有统计学意义(P均<0.05)。随访3个月和6个月时患者呕血、黑便等消化道出血情况观察组均小于对照组,差异有统计学意义(P<0.05)。结论雷贝拉唑钠肠溶可降低小剂量阿司匹林治疗中发生溃疡出血的风险。

Objective To investigate the preventive effect of rabeprazole on peptic ulcer induced by low- dose aspirin. Methods The patients （n=166） with cardiovascular diseases needing anti-coagulation treatment were chosen from June 2010 to Feb. 2012, and then randomly divided into control group and observation group （each n=83）. The control group was only given aspirin （100 mg, qd） and observation group, rabeprazole enteric capsules （20 mg, qd） besides of aspirin. The gastrointestinal symptoms including epigastric discomfort and pain, heartburn, sour regurgitation, mucosa changes under gastroscope, and gastrointestinal bleeding symptoms including hematemesis and melena were compared between two groups. Results There were 37 cases （44.6%） with gastrointestinal symptoms in observation group and 4 （4.8%） in control group. There were 29 （34.9%） with gastrointestinal mueosa lesions in control group, among which 12 （14.5%） with peptic ulcer, and 6 （7.2%） with gastrointestinal mucosa lesions in observation group, among which only 1 （1.2%） with peptic ulcer. The incidences of gastrointestinal symptoms, gastrointestinal mucosa lesions and peptic ulcer were significantly lower in observation group than those in control group （all P〈0.05）. After follow-up for 3 months and 6 months, the incidence of gastrointestinal bleeding symptoms was lower in observation group than those in control group （P〈0.05）. Conclusion Rabeprazole enteric capsules can reduce the bleeding risk during treatment of peptic ulcer with low-dose aspirin.