课件：相关胃肠道损伤的应用.ppt

* Moore研究荟萃分析了2003年10月以前，所有关于塞来昔布治疗关节炎的随机、双盲、对照研究，共计31项（纳入患者39,605例，患者平均用药时间7个月），旨在探讨塞来昔布治疗骨关节炎（OA）/类风湿关节炎（RA）不良事件发生率。 研究证实，塞来昔布上消化道安全性显著优于非选择性NSAIDs：塞来昔布组的症状性溃疡和胃肠道出血的发生率低于非选择性NSAIDs组；血红蛋白减少的发生率、因胃肠道不耐受所致的停药率，塞来昔布组也显著低于非选择性NSAIDs组。 这一结论再次证实，长期服用塞来昔布治疗OA/RA的良好的消化道耐受性及安全性。 1. McGettigan et al. JAMA. 2006. * * * 在健康志愿者中，应用先进的胶囊内窥镜，进行了一项为期2周的关于下消化道的随机双盲、安慰剂对照的前瞻性研究，评估塞来昔布与非选择性NSAIDs合用PPI对小肠损伤的发生率。 结果显示：塞来昔布组小肠粘膜损伤发生率比布洛芬合用奥美拉唑组低71%（P.001 ）。 研究结果提示我们：非选择性NSAIDs，即使与胃肠粘膜保护剂联用，仍不能充分保护小肠粘膜的损伤。而塞来昔布对下消化道的安全性更为突出。 1. Goldstein JL, Eisen G, Lewis B, Gralnek I, Zlotnick S. Small bowel mucosal breaks associated with ibuprofen plus omeprazole, celecoxib, or placebo in healthy subjects as determined by video capsule endoscopy: results from a multicenter, double-blind, randomized, controlled trial. Presented at: American College of Rheumatology 68th Annual Scientific Meeting; October 17-21, 2004; San Antonio, Tex. Abstract L12. * 一个理想的miRNA应该符合以上四个标准，而实际上偏差是可能的，最低限度是22nt和发夹前体的存在被证实。 * * * * * * As we reviewed earlier, low-dose ASA even by itself can be problematic in high-risk patents. 正如我们以前所说，对于高危患者来说小剂量的ASA本身就是一个问题。 Lai and colleagues in 2002 reported a study of a group of patients hospitalized because of complicated ulcer disease (mainly bleeding) and who had been taking aspirin at a dose of only 100 mg per day. All patients were H. pylori positive. The ulcers were healed by treating the H. pylori infection. After ulcer healing and treatment of H. pylori infection, aspirin therapy was re-initiated and patients were also randomized to a PPI, lansoprazole 30 mg daily, or to placebo. Recurrent ulcer bleeding was extremely rare in those patients given lansoprazole with aspirin, while it occurred in almost 15% of those receiving aspirin. Lai及其同事，在2002年报道了一项临床研究。受试者因溃疡并发症（主要是出血）而住院，这些受试者每日服用阿司匹林的剂量仅为100mg/d。所有患者都存在HP感染。这些患者都进行了HP根除治疗和溃疡治疗。之后，患者重新开始使用阿司匹林，并随机分为PPI组（兰索拉唑30mg/d）和安慰剂组。研究结果显示：同时使用兰索拉唑和阿司匹林患者的溃疡再出血率非常之低，但安慰剂组的这一比例却接近15%。 * * * * * * * * According to the consensus