AP&T: 低剂量阿司匹林的使用会增加胃和十二指肠溃疡风险

2022-06-26 xuyihan MedSci原创

胃肠道症状是阿司匹林最常见的不良反应,较常见的症状有恶心、呕吐、上腹部不适或疼痛等。口服阿司匹林可直接剌激胃黏膜引起上腹不适及恶心呕吐。长期使用易致胃黏膜损伤,引起胃溃疡及胃出血。

乙酰水杨酸,通常被称为“阿司匹林”,它是通过不可逆的乙酰化过程抑制血小板聚集。指南建议每日低剂量75-325mg,可以用于心肌梗塞和不稳定型心绞痛的早期治疗以及动脉粥样硬化性心血管疾病的一级和二级预防此外,最近的研究提供的证据表明,低剂量阿司匹林可能有助于预防结肠直肠癌和痴呆症的发生。然而,低剂量阿司匹林治疗已被证明会增加消化性溃疡病的风险,长期使用阿司匹林与上消化道事件风险增加 2 至 4 倍相关。由于 80%的内镜检查证实的胃十二指肠溃疡病例无症状,因此受到低剂量阿司匹林不利影响的实际患者人数可能甚至比报告的还要多。本项研究旨在探究低剂量阿司匹林使用与胃和十二指肠溃疡病发病率的关系,

为了完成本项研究,研究人员使用了两个前瞻性队列的数据:来自德国的 ESTHER 研究和来自英国生物银行的初级保健数据。研究人员将在基线或2年随访内以≤300 mg/天的剂量使用阿司匹林定义为是低剂量阿司匹林使用者。然后研究人员通过病例数据收集患者的消化道溃疡的发生情况,并进行统计学分析。

研究结果发现在两个队列中低剂量阿司匹林的使用和胃溃疡之间没有显着关联。此外,低剂量阿司匹林与英国生物库中普遍存在的十二指肠溃疡存在微弱的统计学显着相关性(风险比: 1.27;[95% 置信区间]: [1.07-1.51]),但在 ESTHER 研究中则没有这样的相关性(风险比:1.33;[95% 置信区间]: [0.54-3.29] )。当只研究阿司匹林使用新用户时,胃和十二指肠溃疡病的风险比分别为 1.82 [1.58–2.11] 和 1.66 [1.36–2.04]。

这项研究表明,低剂量阿司匹林是胃和十二指肠溃疡的独立危险因素。在两个队列中,研究人员发现新使用阿司匹林的患者存在强关联且具有统计学意义。因此,重要的是在开始低剂量阿司匹林治疗时权衡风险与收益,并在开始低剂量阿司匹林治疗后监测不良胃肠道症状。

原始出处:

Thi Ngoc Mai Nguyen. Et al. Strongly increased risk of gastric and duodenal ulcers among new users of low-dose aspirin: results from two large cohorts with new-user design. Alimentary Pharmacology & Therapeutics.2022.

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    2022-06-26 weigq

    权衡利弊。

    0

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    2022-06-26 ms2000001936584832

    感谢#学习#

    0

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