摘要
目的评价质子泵抑制剂（PPI）预防非甾体类抗炎药（NSAID）相关性溃疡复发的临床疗效和安全性。方法检索中国生物医学文献数据库、Medline等，纳入PPI预防NSAID相关性溃疡复发的所有临床随机对照试验。采用Cochrane协作网提供的RevMan4．2软件进行荟萃分析。结果10项随机临床试验共3361例患者纳入研究。荟萃分析结果显示，PPI显著降低NSAID相关性溃疡的复发率（8．7％），与对照组比较差异有统计学意义（17．2％，P=0．03）。其中，接受埃索美拉唑治疗和兰索拉唑治疗的患者溃疡复发率明显减低（4．4％和18．0％），与对照组比较差异均有统计学意义（14．7％和28．7％，P值分别为0．01和0．05），而奥美拉唑组与对照组相比并无明显优势（P=0．16）。不同剂量PPI比较，埃索美拉唑20mg／d、40mg／d和兰索拉唑15mg／d组NSAID溃疡的复发率分别为4．4％、4．3％和19．7％。将NSAID分层分析发现，PPI可有效预防非选择性NsAID溃疡的复发（P=0．009），但对选择性环氧合酶2抑制剂无明显优势（P=0．58）。未发现PPI治疗组和对照组发生明显的药物不良反应。结论以埃索美拉唑为主的PPI在不停用NSAID的情况下，能有效预防已经发生的NSAID相关性溃疡的复发，疗效可靠、耐受性好。
Objective To assess tbe clinical efficacy and safety of proton pump inhibitors （PPI） for preventing recurrence of non-steroidal anti-inflammatory drugs （NSAIDs）-induced upper gastrointestinal ulcers using meta-analysis. Methods Mono- or multicenter randomized controlled clinical trials related to NSAIDs-induced ulcers were retrieved from database of China Biological Medicine and Medline from 1966 to 2007. The data were analyzed by RevMan 4. 2 software using random or fixed effects model. Results Ten randomized controlled trials including 3361 patients were included. The meta-analysis revealed that PPI treatment significantly reduced the recurrent rate of NSAIDs-associated ulcers （8.7%） in comparison with controls （17.2%, P=0. 03）. Those who received esorneprazole （4. 4%） or lansoprazole （18. 0%） had a low recurrence of peptic ulcers compared with controls （14.7% or 28.7%, P value 0.01 or 0. 05）. But there was no significant differencebetween omeprazole and controls （P=0. 16）. The recurrence of NSAIDs associated ulcers in patients treated with esomeprazole 20 mg or 40 mg and lansoprazole 15 mg were 4.4%, 4.3% and 19.7% respectively. The stratify analysis showed that PPI therapy could effectively reduce recurrentce of non-selective NSAIDs-induced ulcer （P= 0. 009）, but failed to selective cyclooxygenase （COX）-2 inhibitor induced ulcer. No severe adverse reactions were found in PPI groups. Conclusion PPI is effective and safe in prevention of NSAIDs-related ulcers without discontinuation of NSAIDs.
出处
《中华消化杂志》
CAS
CSCD
北大核心
2009年第7期471-475,共5页
Chinese Journal of Digestion
关键词
质子泵抑制剂
非甾体类抗炎药
随机临床试验
荟萃分析
Proton pump inhibitors
Anti-inflammatory agents, non-steroidal
Randomized controlled trials as topic
Meta-analysis
