美国胃肠病学会（AGA）有关开据 NSAIDs药品的建议

衍生物类抗抑郁药的系统设计值得注意高发肠道缺血性初步合意拟定推荐建议来增加高风险据宾夕法尼亚州肠胃病人文学科委员会召集的多学科初步介绍，衍生物类抗抑郁药给有适应症的病患提供了广阔的诱因，但是医疗政府部门在给病病患放据这类药物之前，只能仔细考虑它的值得注意高风险。肠道病变是使用非类抗抑郁药的最常见的低血糖，除此以外上肠胃和下肠胃的缺血性。严重的肠道缺血性，如潜在的致命性并发症性病变，年再次发生率为使用者的1－4％。初步的辩论结果“关于拟定衍生物类抗抑郁药除此以外外环羟化激酶－2以致于剂和低剂量的系统设计建议辩论会的一致意见”发表在宾夕法尼亚州肠胃病人文学科委员会年出版的9月份的《临床肠胃病学与胰脏病学》杂志上。“衍生物类抗抑郁药是世界各地系统设计最最常的药物，而且最常的系统设计断定了它的功效和相对可靠性” 据密苏里所大学布拉德福德分校内科学研究教授，科学论文的主要作者C. Mel Wilcox芝加哥所大学介绍。“但是，过去虽然充分认识了肠道缺血性，而没有认识到其心脏凶险，宾夕法尼亚州肠胃病人文学科委员会召集立法机构来提高对系统设计该类药物的诱因和肠道及哮喘毒性的高风险，从而改进对该类药物的系统设计。”估计世界各地每年消耗500亿低剂量片，其中宾夕法尼亚州大约6000万份处方放据了低剂量，并主要给老年病病患。这类药物对急、慢性疼痛和骨骼肌肉炎症等之外有效。但是，衍生物类抗抑郁药的使用值得注意着严重的凶险，除此以外肠道、肾脏和哮喘缺血性，甚至除此以外心力衰竭和缺血性。“我们欣喜地看到衍生物类抗抑郁药的肠道缺血性和死亡已经从1992年放始下降，我们相信这种状况便是一下之外：小剂量使用衍生物类抗抑郁药；降极低了幽门百日咳的流行；提高了质子泵以致于剂的系统设计；以及引进对肠道来得安全的衍生物类抗抑郁药的系统设计，如昔布类药物。” Wilcox芝加哥所大学知道。“但是，医疗政府部门和病病患只能了解该类药物的相关高风险来拟定衍生物类抗抑郁药的最佳系统设计建议。初步为医疗政府部门拟定了当他们在决定是不是给病病患放衍生物类抗抑郁药时的以下建议：赞赏病患的适应症和病病患再次发生肠道和哮喘缺血性的潜在凶险因子，并和病病患辩论哮喘疾病的潜在凶险因子。对高风险和诱因进行分析来衡量个体肠道和哮喘凶险后，放据极低高风险的药物。肠道并发症再次发生凶险大的病患只能系统设计肠道高风险极低的衍生物类抗抑郁药，例如非丝氨酸衍生物类抗抑郁药；哮喘政治事件再次发生高风险大的病患只能给与外环氧激酶－2以致于剂病患；有仅有哮喘疾病或哮喘病高风险的病病患只能给与小剂量低剂量。限制所放衍生物类抗抑郁药的持续时间和剂量，以及征询并建议病病患进行衍生物类抗抑郁药的联合病患。在系统设计衍生物类抗抑郁药病患之前，先妥善处理幽门百日咳的感染，以致不提高并发消化性病变的高风险。针对肠道缺血性高风险大的病患拟定肠胃必要措施建议，如系统设计米索之前列醚或质子泵以致于剂。“衍生物类抗抑郁药的系统设计值得注意极低肠道缺血性在诊断和病患上很重要，” Wilcox芝加哥所大学解释知道。“来得好地表达出来极低肠道并发症再次发生的高风险和机理是下降衍生物类抗抑郁药的使用凶险所只能的。”在立法机构期间辩论的药剂都是非类以致于炎症反应的药物，因此在人文学科上被相信是衍生物类抗抑郁药。非丝氨酸的衍生物类抗抑郁药，除此以外低剂量、依托度酸和萘丁美酮，它们比其他衍生物类抗抑郁药，例如舒林酸、吲哚美辛、吡罗昔康和酮咯酸对肠道具有极高的可靠性。昔布类药物是丝氨酸外环羟化激酶－2类似物。在标准剂量下，扑热息痛不是衍生物类抗抑郁药。宾夕法尼亚州肠胃病人文学科委员会初步由肠胃病学、风湿病学、心脏病学和内科学研究医师构成，他们在小组辩论后，以当之前科研院所报告为了将拟定了这个建议。宾夕法尼亚州肠胃病人文学科委员会举办的“关于衍生物类抗抑郁药的系统设计的立法机构”由TAP酒类公司提供的一项无限教育基金资助。与会代表的财政放销公布包含在原稿内，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.撰稿：bluelove 撰稿： Zhu