消化性溃疡史患者中小剂量阿司匹林相关的胃肠损伤预防性治疗的系统评价与Meta分析  

Systematic review and Meta-analysis of preventive treatment for low-dose Aspirin-associated gastrointestinal injury in patients with history of peptic ulcer

作　　者：万宁[1] 张田甜[2] 董艳敏 杨晨[1] 季波[1] WAN Ning;ZHANG Tiantian;DONG Yanmin;JI Bo(Department of Pharmacy, Guangzhou General Hospital of Guangzhou Military Command of PLA, Guangdong Province, Guangzhou 510010, China;College of Pharmacy, Ji′nan University, Guangdong Province, Guangzhou 510632, China;Department of Pharmacy, the 154th Central Hospital of PLA, He′nan Province, Xinyang 464000, China)

机构地区：[1]广州军区广州总医院药剂科,广东广州510010 [2]暨南大学药学院,广东广州510632 [3]解放军第一五四中心医院药剂科,河南信阳464000

出　　处：《中国医药导报》2019年第3期109-114,135,共7页China Medical Herald

基　　金：广东省广州市科技计划项目(201709010006)

摘　　要：目的验证质子泵抑制剂(PPIs)和对照药物在长期服用低剂量阿司匹林(LDA)且有消化性溃疡病史的患者中相关胃肠道损伤的预防效果,以减少PPIs在预防用药方面的滥用。方法检索了PubMed、Cochrane图书馆和Embase数据库,更新至2018年5月,收集用于评估预防性治疗[PPIs,H_2受体拮抗剂(H2RA),沃诺拉赞(Vonoprazan)和胃黏膜保护剂]对长期应用LDA引起的胃肠道损伤的疗效的随机对照试验。结果纳入9项研究,共3067例患者。结果显示,PPIs在预防溃疡复发和上消化道出血方面的效果均优于安慰剂和胃黏膜保护剂;Vonoprazan(OR=2.61,95%CI:0.81～8.41)和H_2RA(OR=0.36,95%CI:0.04～3.54)在预防消化性溃疡复发方面与PPIs疗效相似,而在预防上消化道出血方面,Vonoprazan的预防效果优于PPIs,H_2RA的预防效果不如PPIs。在感染幽门螺杆菌引起上消化道出血史的患者中,幽门螺杆菌根除治疗与PPIs具有相似的预防效果(OR=0.50, 95%CI:0.04～5.54)。结论 H_2RA和Vonoprazan在预防消化性溃疡复发方面与PPIs疗效相似,而Vonoprazan在预防溃疡出血方面的效果优于PPIs,且在感染幽门螺杆菌的患者中,根除治疗与PPIs具有相似的预防效果。因此PPIs可能并不是预防消化性溃疡史患者中LDA相关的胃肠损伤的最佳选择。Objective To demonstrate the efficacy of proton pump inhibitors (PPIs) and control drugs in the prevention of low dose Aspirin (LDA) related gastrointestinal (GI) injuries in patients with peptic ulcer history, thus reducing the abuse of PPIs. Methods By searching PubMed, Cochrane Library and Embase database upto May 2018, the randomized controlled trials on the efficacy of preventive therapy [PPIs, H2 receptor antagonist (H2RA), Vonoprazan, and gastric mucosal protective agents] in reducing the risks of GI events in patients taking long term LDA were collected. Results A total of 9 studies were included with a total of 3067 patients. PPIs were superior to placebo and gastric mucosal protective agents in preventing ulcer recurrence and upper gastrointestinal bleeding (UGIB). Vonoprazan (OR = 2.61, 95%CI: 0.81-8.41) and H2RA (OR = 0.36, 95%CI: 0.04-3.54) showed similar efficacy to PPIs in preventing peptic ulcer recurrence. As for prevention of UGIB, Vonoprazan was superior to PPIs, while H2RA was inferior to that of PPIs. In patients with a history of Hp-induced upper GI hemorrhage, Hp eradication treatment had a similar prophylactic effect as PPIs. Conclusion The results suggest that Vonoprazan and H2RA are as effective as PPIs for the prevention of recurrent peptic ulcer, and Vonoprazan exhibits better efficacy for the prevention of UGIB with PPIs. In patients with a history of Hp infection, the eradication treatment has a similar effect as PPIs. Hence, PPIs may not be the best choice for the prevention of LDA associated GI injures.

关 键 词：低剂量 阿司匹林 溃疡史 预防 系统评价 META分析 

分 类 号：R573.1[医药卫生—消化系统]