美国胃肠病学会（AGA）有关开据 NSAIDs处方药的建议

高血压类组胺的领域在在高发肾脏出血工作组合意订立推荐计划来减小危险性据英美两国胃肠病常务理事招集的门类工作组解话说，高血压类组胺给有适应症的病患者透过了广阔的其所，但是健康部门在给病者掀开据这类口服前所，需仔细回避它的在在危险性。肾脏水肿是使用非类组胺的最类似于的不良中间体，之外上消化道和下消化道的出血。致使的肾脏出血，如潜在的致命性肾衰竭溃疡，年愈演愈烈率为使用者的1－4％。工作组的咨询结果“关于订立高血压类组胺之外外环抗坏血酸－2以致于剂和桑洛芬的领域计划研习术会议的共识”发表在英美两国胃肠病常务理事年出版的9月份的《临床胃肠病研习与肝脏病研习》杂志上。“高血压类组胺是世界各地领域最相当多的口服，而且相当多的领域证实了它的药用价值和相比较相容性” 据霍普金斯大研习伯明翰医学院内现代科研习教授，论文的主要作者C. Mel WilcoxClark解话说。“但是，从前虽然充分认识了肾脏出血，而无法认识到其脑干可怕，英美两国胃肠病常务理事招集协商会议来缩减对领域该类口服的其所和肾脏及哮喘疗效的危险性，从而加以改进对该类口服的领域。”估计世界各地每年消耗500亿桑洛芬片，其中英美两国大约6000万份处方掀开据了桑洛芬，并主要给老年病者。这类口服对见、后遗症和骨骼神经呼吸道等特别有效。但是，高血压类组胺的使用在在着致使的可怕，之外肾脏、脑干和哮喘出血，甚至之外心力衰竭和缺血性。“我们高兴地看到高血压类组胺的肾脏出血和丧命已经从1992年掀开始下降，我们认为这种精神状态归功于一下特别：小剂量使用高血压类组胺；降很低了幽门狂犬病的大行其道；缩减了质子泵以致于剂的领域；以及引进对肾脏更安全的高血压类组胺的领域，如昔桑类口服。” WilcoxClark话说。“但是，健康部门和病者需了解该类口服的相关危险性来订立高血压类组胺的最佳领域计划。工作组为健康部门订立了当他们在决定是否给病者掀开高血压类组胺时的以下建言：评价病者的适应症和病者愈演愈烈肾脏和哮喘出血的潜在可怕因子，并和病者咨询哮喘疾病的潜在可怕因子。对危险性和其所进行时量化来衡量个体肾脏和哮喘可怕后，掀开据很低危险性的口服。肾脏出血愈演愈烈可怕大的病患者需领域肾脏危险性很低的高血压类组胺，例如非丝氨酸高血压类组胺；哮喘事件愈演愈烈危险性大的病患者需做外环氧酶－2以致于剂病者；有推断哮喘疾病或哮喘病危险性的病者需做小剂量桑洛芬。容许所掀开高血压类组胺的时间尺度和剂量，以及听取并建言病者进行时高血压类组胺的联合病者。在领域高血压类组胺病者前所，先处理幽门狂犬病的病毒感染，以致不缩减即刻消化性溃疡的危险性。针对肾脏出血危险性大的病患者订立胃肠保护计划，如领域米索前所列醇或质子泵以致于剂。“高血压类组胺的领域在在很低肾脏出血在诊断和病者上很关键性，” WilcoxClark断言话说。“更好地表达出来很低肾脏出血愈演愈烈的危险性和机理是减少高血压类组胺的使用可怕所需的。”在协商会议期间咨询的镇静剂都是非类以致于呼吸道中间体的口服，因此在研习术上被认为是高血压类组胺。非丝氨酸的高血压类组胺，之外不良中间体、依托度酸和萘丁美酯，它们比其他高血压类组胺，例如舒林酸、萘美辛、吡罗昔康和酯咯酸对肾脏具有较高的相容性。昔桑类口服是丝氨酸外环抗坏血酸－2类似物。在标准剂量下，扑热息痛不是高血压类组胺。英美两国胃肠病常务理事工作组由胃肠病研习、风湿病研习、脑干病研习和内现代科研习外科组成，他们在小组咨询后，以当前所科研报告为基础订立了这个计划。英美两国胃肠病常务理事举办的“关于高血压类组胺的领域的协商会议”由TAP药品公司透过的一项无限教育基金私人机构。出席会议的税制掀开销公告包含在抄录内，在www.cghjournal.org. Nonsteroidal anti-inflammatory drugs use associated with higher gastrointestinal complications Consensus panel develops recommendations to minimize risks Nonsteroidal anti-inflammatory drugs (NSAIDs) provide a broad range of benefits for patients who require their use, but health care providers need to carefully consider the associated risks before prescribing these drugs for their patients, according to a multi-disciplinary panel of experts convened by the AGA Institute. Gastrointestinal (GI) morbidities are the most common adverse events associated with NSAID use, including complications in both the upper- and lower-GI tracts; serious GI complications, such as potentially fatal bleeding ulcers, occur in one to four percent of NSAID users annually. The findings of the panel, "Consensus Development Conference on the Use of Nonsteroidal Anti-Inflammatory Agents, Including Cyclooxygenase-2 Enzyme Inhibitors and Aspirin," were published in the September issue of Clinical Gastroenterology and Hepatology, published by the American Gastroenterological Association (AGA) Institute. "NSAIDs are the most widely used medications in the world, and the broad use of these drugs confirms their effectiveness and relative safety," according to C. Mel Wilcox, MD, professor of medicine, University of Alabama at Birmingham, and lead author of the paper. "However, well-recognized GI complications and previously unrecognized cardiac risks he caused great concern about the use of these drugs among healthcare professionals. The AGA Institute convened the consensus conference to increase awareness about the benefits and the risks of GI and cardiovascular toxicities associated with these medications and to improve their use." An estimated 50 billion aspirin tablets are consumed worldwide and approximately 60 million prescriptions are written for NSAIDs each year in the U.S., predominantly for older patients. These drugs are effective in acute and chronic treatment of painful and inflammatory musculoskeletal conditions, among others. However, NSAID use is associated with several risks including GI, renal and cardiovascular complications, including heart failure and myocardial infarction. "We were pleased to note that both NSAID-associated GI complications and death he been decreasing since 1992, which we believe can be attributed to several factors: use of lower-dose NSAIDs; decreasing prevalence of H. pylori; increasing use of proton-pump inhibitors; and the introduction of NSAIDs with greater GI safety, such as coxibs," said Dr. Wilcox. "However, healthcare providers and patients need to be aware of the risks associated with these drugs to develop the best plan for using NSAID therapy." The panel developed the following recommendations for healthcare providers to use when determining whether to prescribe NSAID treatment to their patients: ◎Review the treatment indication and potential patient risk factors, both for GI and cardiovascular complications, and discuss potential cardiovascular risk factor modifications with their patients. ◎Prescribe lower-risk agents after conducting a risk-benefit ysis to determine the GI versus cardiovascular risks for each individual. Patients who are at greater risk of GI bleeding should receive NSAIDs with lower GI risks, such as nsNSAIDs; patients with a greater risk of cardiovascular events should not receive COX-2 inhibitors; and patients with known or a high risk of cardiovascular disease should receive low-dose aspirin. ◎Limit the duration and dosage of the prescribed NSAID and ask about and advise their patients on combination NSAID therapy. ◎Treat patients with H. pylori infection prior to beginning NSAID therapy so as not to increase the risk of complicated ulcers. ◎Institute gastroprotection methods, such as misoprostol or proton pump inhibitors (PPIs), for patients at high-risk of GI complications. "The association of NSAID use with lower-GI tract complications is important diagnostically and therapeutically," explained Dr. Wilcox. "A better understanding of risk factors for and mechanisms of lower-GI tract bleeding in NSAID users will be required to address risk reduction." All agents discussed during the consensus conference were nonsteroidal, inhibit inflammation, and thus are technically considered NSAIDs. Nonselective NSAIDs include ibuprofen, etodolac and nabumetone, which may he superior GI safety than other nsNSAIDs, such as sulindac, indomethacin, piroxicam and ketorolac. Coxibs are selective NSAIDs. In standard doses, acetaminophen is not an NSAID. The AGA Institute panel was comprised of physicians in gastroenterology, rheumatology, cardiology and internal medicine who developed the statement based on presentations of current scientific knowledge followed by group discussion. The AGA Institute "Consensus Development Conference on the Use of Nonsteroidal Anti-Inflammatory Agents" was supported though an unrestricted educational grant from TAP Pharmaceutical Products Inc. Financial disclosures for conference participants are included in the manuscript at www.cghjournal.org.总编辑：bluelove 总编辑： Zhu