伏诺拉生致胃组织病理性改变16例文献分析

Analysis of 16 cases of related histopathological change in stomach induced by vonoprazan based on literature

目的分析伏诺拉生致胃组织病理性改变的发生情况和特点,为临床安全用药提供参考。方法以“伏诺拉生”、“钾离子竞争性酸阻断剂”和“致”、“例”、“相关性”及“vonoprazan”、“takecab”、“potassium-competitive acid blocker”、“P-CAB”和“induced”、“associated”、“caused”、“related”、“followed”、“lead to”、“case”、“cases”为检索词,检索建库至2021年12月收录在中国知网、万方、维普、PubMed和Embase数据库有关伏诺拉生致胃组织病理性改变的病例报道,提取相关数据进行整理和分析。结果共纳入10篇文献,涉及伏诺拉生致胃组织病理性改变16例,其中男性9例(56%),女性7例(44%),年龄43~89岁。伏诺拉生疗程为4~208周,其中大于52周6例(37%)。有8例(50%)内窥镜下表现为胃黏膜发红,4例(25%)为胃黏膜白斑,2例(12%)为胃息肉,其余2例分别为胃黏膜裂纹和胃黏膜白色小颗粒结节。病理报告壁细胞突起13例次(34%),腺体扩张12例次(32%),炎症细胞浸润8例次(21%),灶性出血及充血4例次(10%),腺癌1例次(3%)。所有患者血清胃泌素水平均明显升高。经停药或调整治疗方案后均转归良好。结论伏诺拉生致胃组织病理性改变以黏膜发红和白斑多见,对于长期服用的患者需定期行内窥镜检查,一旦发现异常应及时处理。

AIM To explore and analyze the occurrence and characteristics of vonoprazan-related histopathological change in stomach in order to provide references for clinical safety drug use.METHODS“Vonoprazan/takecab/potassiumcompetitive acid blocker/P-CAB”and“induced/associated/caused/related/followed/lead to/case/cases”were selected as the keywords.The case report of histopathological change in stomach induced by vonoprazan were collected and analyzed statistically from CNKI,VIP,Wanfang,PubMed and Embase database from establishment of each database to December,2021.RESULTS A total of 16 cases from 10 articles were identified and included in the analysis.There were 9 males(56%)and 7 females(44%).Patients were aged from 43 to 89 years old.The treatment course of vonoprazan was 4 to 208 weeks,of which 6 cases(37%)were more than 52 weeks.Eight cases(50%)presented with gastric mucosal redness,four cases(25%)presented with white globe appearance in mucosa of stomach,two cases(12%)presented with gastric polyps,and the remaining two cases presented with gastric mucosa cracks(6%)and small white nodules(6%),respectively.Pathological results showed that there were 13 cases of parietal cell protrusion(34%),12 cases of glandular dilation(32%),8 cases of inflammatory cell infiltration(21%),4 cases of focal hemorrhage and hyperemia(11%),1 case of adenocarcinoma(3%).Serum gastrin levels were significantly increased in all patients.The prognosis was good after drug discontinuation or adjustment of the treatment regimen.CONCLUSION The pathological changes of gastric tissue caused by vonoprazan are more common in mucosal redness and leukoplakia.For patients who take it for a long time,endoscopy should be performed regularly,and once found,it should be dealt with in time.