NSAIDs相关性溃疡再出血的预防

Strategies for prevention of rebleeding after NSAIDs-related ulcers

目的:分别比较经内镜下止血后替普瑞酮联合短期与长期应用奥美拉唑的抑酸疗法对预防非甾体抗炎药(non-steroid anti-inflammtory drugs,NSAIDs)相关性溃疡再出血的疗效和安全性.方法:对因NSAIDs致溃疡出血的患者经内镜下止血后,随机分为替普瑞酮组(28例)、奥美拉唑组(33例)、短期联合组(31例)、长期联合组(35例),比较4组患者在第0-13、14-26周以及第0-26、27-52周期间再出血和不良反应的发生率.结果:4组患者再出血发生人数,经比较在第0-13周替普瑞酮组高于其他3组(P<0.05),而后3组间差异相仿(P>0.05);第14-26周各组间无明显差异(P>0.05);第27-52周期间各组间差异相仿(P>0.05).4组患者发生不良反应的人数经比较第0-26周各组间差异无统计学意义(P>0.05);第27-52周奥美拉唑组与长期联合组间差异无统计学意义(P>0.05),但均高于短期联合组(P<0.05).结论:替普瑞酮联合短期应用质子泵抑制剂(proton pump inhibitors,PPI)的方案与长期使用PPI或长期两药合用的治疗方案对预防NSAIDs相关性溃疡再出血的疗效相当,但相关药物并发症的发生显著减少.

AIM： To compare the therapeutic efficacy and safety of teprenone combined with short- versus long-term use of omeprazole in the prevention of re-bleeding after endoscopic hemostasis for NSAIDs-related ulcers. METHODS： Patients with NSAIDs-related ul- cers who underwent Monteggia liquid spraying for bleeding were randomly divided into four groups： a teprenone group （n -- 28）, an omeprazole group （n = 33）, a short-term combination group （n = 31）, and a long-term combination group （n = 35）. The incidences of re-bleeding and adverse reactions occurring during the periods of 0-13, 14-26, 0-26 and 27-52 wk were compared among the four groups. RESULTS： The rate of re-bleeding occurring between 0 and 13 wk was significantly higher in the teprenone group than in the other groups （all P 〈 0.05）, and the differences were not statisti- cally significant between the other three groups （all P 〉 0.05）. During the periods between 14 and 26 weeks and between 27 and 52 wk, there were no statistically significant differences in the rates of re-bleeding between the four groups （all P 〉 0.05）. The incidences of adverse reac- tions showed no significant differences between the four groups during the period of the first 26 weeks （all P 〉 0.05） or between the omeprazole group and long-term combination group dur- ing the period between 27 and 52 wk （P 〉 0.05）, but were significantly higher in the omeprazole group and long-term combination group than in the short-term combination group （both P 〈 0.05）. CONCLUSION： Teprenone in combination with short-term use of omeprazole has comparable efficacy to long^term use of omeprazole but is associated with significantly less adverse reac- tions in preventing the occurrence of re-bleeding after NSAIDs-related ulcers.