长期服用NSAID人群胃十二指肠黏膜损伤的临床流行病学研究及临床干预

Epidemiology and Clinical Intervention of Gastroduodenal Mucosa Injury on Patients with Long-Term Use of Non-Steroidal Anti-Inflammatory Drugs

目的探讨长期服用NSAID人群胃十二指肠黏膜损伤的临床流行病学及干预效果。方法以我院风湿免疫专科及心血管门诊2012年1月至2014年9月期间所收治204例长期服用NSAID药物患者为观察组,204例非NSAID药物服用者为对照组。比较两组的黏膜损伤评分、消化道症状评分,根据不同方式对患者继续分组,以明确临床干预在减轻该人群胃十二指肠黏膜损伤方面效果。结果 204例NSAID人群中,187例(91.7%)患者存在胃十二指肠黏膜损伤,显著高于非NSAID人群的22.5%(P<0.05);Hp阳性患者胃肠黏膜损伤发生率为98.0%,显著高于Hp阴性患者的85.8%(P<0.05)。干预组与非干预组、根除组与非根除组随访开始前胃肠黏膜损伤评分、消化道症状评分的比较均无显著差异(P>0.05);随访结束时干预组胃肠黏膜损伤评分、消化道症状评分显著低于非干预组(P<0.05),4例(7.5%)患者存在溃疡并发症,显著低于非干预组28.3%(P<0.05);根除组胃肠黏膜损伤评分、消化道症状评分显著低于非根除组(P<0.05),6例(12.2%)患者存在损伤情况,显著低于非根除组34.7%(P<0.05)。结论长期服用NSAID人群普遍存在胃肠黏膜损伤情况,且Hp感染人群概率更高。对未发生Hp感染人群,胃肠黏膜保护剂可减轻损伤,而Hp感染人群则需首先根除Hp再应用胃肠黏膜保护剂,以更好地保护其胃肠道。

Objective To explore the epidemiology and intervention effect of gastroduodenal mucosa injury on patients with long-term use of non-steroidal anti-inflammatory drugs CNSAID）. Methods 204 patients with long-term use of NSAID from January 2012 to September 2014 were selected as the observation group, and 204 patients without long-term use of NSAID were selected as the control group. Both groups were divided into subgroups according to the intervention situation. The mucosal injury scores and gastrointestinal symptom scores were compared. Results Among 204 patients of observation group, 91.7% （187/204） had gastroduodenal mucosa injury, significantly higher than 22.5% of control group （P 〈0.05）; 98.0% Hp-positive patients had gastroduodenal mucosa injury, significantly higher than 85.8% of Hp-negative patients （P 〈0.05）. No statistical difference was found before follow-up between intervention group and non-intervention group, eradication group and non-eradication group （P 〉0.05）. At the end of follow-up, the mucosal injury score and gastrointestinal symptom score of intervention group were significantly lower than those of non-intervention group （P 〈0.05）, and the incidence of ulcer complications was 7.5%, significantly lower than 28.3% of non-intervention group （P 〈0.05）; The mucosal injury score and gastrointestinal symptom score of eradication group were significantly lower than those of non-eradication group （P 〈0.05）, and the incidence of ulcer complications was 12.2%, significantly lower than 34.7% of non-eradication group （P〈0.05）. Conclusions Patients with long-term use of NSAID usually have gastroduodenal mucosa injury, and Hp-positive patients have higher incidence. For patients without Hp infection, gastrointestinal mucosal protective agent can reduce damage; but for patients with Hp infection, gastrointestinal mucosal protective agent should be used after Hp eradication, so as to protect gastrointestinal tract preferably.