Drug Saf:没有帮凶 糖皮质激素也能引发消化性溃疡出血?

2018-03-19 石岩 环球医学

除幽门螺杆菌外,非甾体抗炎药(NSAIDs)是消化性溃疡最臭名昭著的主要原因之一。当NSAID与糖皮质激素(GC)联合使用时,溃疡风险进一步增加,研究者猜测可能是因为GC干扰了伤口愈合过程。然而,是否因GC本身也是导致溃疡的元凶,从而引发独立于NSAID的消化性溃疡出血(PUB)事件,仍存在争议。

除幽门螺杆菌外,非甾体抗炎药(NSAIDs)是消化性溃疡最臭名昭着的主要原因之一。当NSAID与糖皮质激素(GC)联合使用时,溃疡风险进一步增加,研究者猜测可能是因为GC干扰了伤口愈合过程。然而,是否因GC本身也是导致溃疡的元凶,从而引发独立于NSAID的消化性溃疡出血(PUB)事件,仍存在争议。

为此,2018年2月,发表在《Drug Saf》的一项由瑞士和美国科学家进行的病例对照分析,旨在考察GC联合或不联合NASID与PUB之间的相关性。

研究人员使用瑞士健康保险公司的索赔数据进行了一项病例对照研究,确定纳入2012~2016年的1191例PUB病例,并根据年龄、性别、地区和参加保险年数,对每个病例匹配10例无PUB的对照。研究人员使用多变量条件逻辑回归分析比较了病例和对照间既往GC暴露情况,并控制了一些潜在的混杂因素。联合或不联合NSAID的患者单独进行分析。

结果显示,既往GC和NSAID都暴露的患者发生PUB的可能性是既未使用GC也未使用NSAID的患者的5倍(调整比值比[OR],4.80;95% CI[置信区间],3.55~6.71)。仅使用NSAID的患者PUB风险增加了3倍(调整OR,3.20;95% CI,2.59~3.95),而仅使用GC的患者PUB风险只是中度增加(1.63;1.20~2.42)。

研究发现,与GC单药治疗相比,NSAID联合或不联合GC与PUB风险显着增加相关。但除4项研究得出了类似的结果,其他观察性研究仅发现在同时接受NSAID和GC的使用者中,PUB的相对风险增加。

也有一种观点认为,目前GC单药治疗有中度增加PUB的风险,尽管这种风险的增加在最近或过去的GC单药使用者中不再明显。然而,目前还不清楚这种增加是因果关系还是归因于GC使用指征的混淆。需要进一步的研究来阐明GCs是否直接参与PUB的发病机制,以及在接受GC治疗的患者中使用质子泵抑制剂或其他肠胃保护性药物是否合理。

原始出处:

Ian C. ScottSamantha L. HiderDavid L. Scott, et al. Thromboembolism with Janus Kinase (JAK) Inhibitors for Rheumatoid Arthritis: How Real is the Risk? Drug Saf (2018). https://doi.org/10.1007/s40264-018-0651-5

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    2018-07-06 wangbingxhy
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    2018-03-22 易水河

    糖皮质激素使用必须慎重

    0

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    2018-03-22 1209e435m98(暂无昵称)

    学习了.谢谢分享

    0

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    2018-03-19 changjiu

    学习了.谢谢

    0

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