质子泵抑制药加重非甾体抗炎药所致小肠损伤及其防治措施的文献综述

Proton Pump Inhibitors Aggravate Intestinal Injuries Caused by Non-steroidal Anti-inflammatory Drugs and Treatment Measures

质子泵抑制药(PPIs)可有效治疗胃和十二指肠的损伤出血,但对非甾体抗炎药(NSAIDs)所致小肠损伤效果不佳,甚至加重损伤的程度。PPIs通过改变肠道菌群和增加胆汁酸的细胞毒性等机制加重NSAIDs药物引起的小肠损伤,联合用药前应充分评估患者的获益及风险,治疗时需兼顾上下消化道,可选用具消化道黏膜保护功能的特殊组胺H2受体拮抗药如拉呋替丁;尽可能选用对消化道影响较小的NSAIDs药物如选择性COX-2抑制药;补充肠道益生菌,纠正肠道微生态;使用消化道黏膜保护药物;必要时使用肠道的局部抗菌药。考虑到COX-2抑制药和PPIs的心血管风险,对于患有心脑血管疾病和存在心脑血管疾病风险的患者,应慎用此两类药物。

PPIs may effectively treat upper gastrointestinal injuries,however,it is not effective for small intestinal injuries caused by NSAIDs,and even aggravate the degree of the injuries. Its enteropathy mechanisms are related to altering intestinal flora and increasing cytotoxicity of bile acids. Patients should be fully evaluated for their benefits and risks before combination therapy,the unreasonable use of PPIs should be reduce or stop. The upper and lower digestive tract should be considered together when selecting drugs. Lafutidine,a special histamine H2 receptor with digestive tract mucosal protection effect,can be used as an alternative medicine of PPIs. NSAIDs with less impact on the digestive tract, such as selective COX-2 inhibitors,can be used as much as possible,Supplementing intestinal probiotics can correct intestinal microecology. Digestive mucosal protective agent and intestinal antibiotics can be used when necessary. Considering the cardiovascular risk of COX-2 inhibitors and PPIs. These two drugs should be used with caution in patients with cardiovascular and cerebrovascular diseases and risk.