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RevMan 4.2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20 mg/d、40 mg/d和兰索拉唑15 mg/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.

abstractsObjective To assess the clinical efficacy and safety of proton pump inhibitors (PPI)for preventing recurrence of non-steroidal anti-inflammatory drugs (NSAIDs)-indueed upper gastrointestinal ulcers using meta-analysis. Methods Mono- or multicenter randomized controlled clinical trials related to NSAIDs-indueed 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 recta-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 esomeprazole (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 tansoprazole 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.