瑞巴派特对各种原因引起的胃溃疡愈合状况的疗效观察
开篇：润墨网以专业的文秘视角，为您筛选了一篇瑞巴派特对各种原因引起的胃溃疡愈合状况的疗效观察范文，如需获取更多写作素材，在线客服老师一对一协助。欢迎您的阅读与分享！
[摘要] 目的 探讨瑞巴派特(膜固思达)对各种原因引起的胃溃疡愈合状况的影响。方法 胃窦及胃体取活检证实为胃溃疡的60例患者,根据幽门螺杆菌(Helicobacter pylori,HP)感染状况和非甾体抗炎药(nonsteroidal anti-inflammatory drags,NSAIDs)相关性分组,其中HP感染状况依据快速尿素酶试验、组织病理学检查以及尿素呼气试验判定,NSAIDs相关性依据NSAIDs使用史判定。所有患者均给予瑞巴派特100mg每日3次口服,持续8周。在第4周和第8周进行不良反应随访,最后复查胃镜评价溃疡愈合程度。结果 有NSAIDs使用史的患者大部分完全愈合(70%),所有患者对治疗结果满意且无明显不良反应。结论 瑞巴派特对NSAIDs相关性溃疡疗效显著,可以明显促进溃疡愈合改善临床症状。
[关键词] 瑞巴派特;NSAIDs;HP;胃溃疡
[中图分类号] R573.1 [文献标识码] A [文章编号] 1673-9701(2010)12-48-03
Effect of Rebamipide(mucosta) on Non-steroidal Anti-inflammatory Drugs -related Gastric Ulcer Healing
WANG Minghui
Sihe Mine Branch, General Hospital of Shanxi Jincheng Authracite Mining Group,Jincheng 048025,China
[Abstract] Objective To investigate the effect of rebamipide(mucosta)on gastric ulcer healing caused by various etiologies. Methods Sixty cases of gastric ulcer were grouped based on the helicobacter pylori(HP) infection and the relation to use of(NSAIDs). The helicobacter pylori(HP) infection was determined by using rapid urease test,histopathological examination and the urea breath test,and the relation to NSAIDs was evaluated by the NSAIDs-taking history. All patients received rebamipide 100 mg,three times a day,for 8 weeks. The adverse effects were assessed at Weeks 4 and 8 after administration. At the end of the present study,the endoscopic evaluation of ulcer healing was carried out. Results Ulcers were completely healed(70%) in most patients with NSAIDs-related ulcer.All patients were satisfied with the therapy results due to few adverse effects. Conclusion Rebamipide has a significant effect on NSAIDs-related ulcer and can clearly improve the clinical symptoms to promote ulcer healing.
[Key words] Rebamipide;Non-steroidal anti-inflammatory drugs;Helicobacter pylori;Gastric ulcer
消化性溃疡是全球性多发病,特别是发展中国家的发病率目前有增无减,其中不乏反复复发患者。其发生主要是攻击因子(胃酸分泌)与防御因子(包括黏液黏膜屏障、黏膜血流及上皮再生)之间失衡所致,幽门螺杆菌(Helicobacter pylori,HP)感染和非甾体抗炎药(nonsteroidal anti-inflammatory drags,NSAIDs)的应用也是两大危险因素[1]。当前临床上对这类疾病的处理主要是减少胃酸的分泌(H2受体拮抗剂和质子泵抑制剂)、胃黏膜保护剂的应用(吉法酯、硫糖铝、铝碳酸镁)及幽门螺杆菌的清除。
瑞巴派特(膜固思达)作为一种新型抗溃疡药可增加前列腺素合成、促进表皮生长因子及其受体表达、抑制中性粒细胞激活、清除氧自由基等。目前研究表明它对各种实验性胃溃疡有效,可促进前列腺素产生,保护胃黏膜免受各种致溃疡因子的危害,有较高的临床应用价值[2]。本研究的目的旨在探讨其对HP感染同时伴或不伴NSAIDs相关性和无HP感染同时不伴NSAIDs相关性患者愈合的影响。
1资料与方法
1.1一般资料
选择标准:①年龄>18岁;②育龄期女性需要采取避孕措施,绝经期、子宫全切术3个月以上及输卵管结扎的女性也可入选;③无严重心、肺、肝、肾疾病者;④无使用H2受体拮抗剂和质子泵抑制剂史患者;⑤均由胃镜证实为胃溃疡活动期,大小0.5～2.5cm,数目不超过2个,经病理检查除外恶性肿瘤。选择2008年1月～2009年12月符合上述标准的我院消化科、风湿科、骨科、心内科门诊及住院患者60例。所有患者都行胃镜取活组织4处(2处来源于胃窦,2处来源于胃体)用于快速尿素酶试验、组织病理学检查及尿素呼气试验。三项检查中有一项为阳性即判定为HP阳性,三项都为阴性判定为HP阴性。在7d内以任何剂量使用过NSAIDs或在2～3个月内服用小剂量阿司匹林预防暂时性脑缺血发作、心肌梗塞的患者认定为NSAIDs相关性阳性。根据HP感染状况和NSAIDs相关状况划分为四组:①HP+NSAIDs+组14例,男8例,女6例,年龄平均55.14岁;②HP+NSAIDs-组18例,男10例,女8例,年龄平均52.78岁;③HP-NSAIDs+组6例,男0例,女6例,年龄平均61.33岁;④HP-NSAIDs-组22例,男10例,女12例,年龄平均58.18岁。四组一般资料差异无统计学意义(P>0.05),具有可比性。
1.2试验方法
全部患者给予瑞巴派特(黑龙江省惠利达医药有限公司生产,批号:20080104)100mg每日3次,疗程为8周。8周后复查胃镜,观察溃疡愈合情况。在第4周和第8周进行症状学随诊,并检查血、尿、大便常规及肝肾功能,观察药物的不良反应。
1.3疗效判断标准[3]
完全愈合:溃疡愈合,周围炎症消失;基本愈合:溃疡愈合,周围仍有炎症;有效:溃疡面缩小50%以上或溃疡减少;无效:溃疡愈合不到50%,或无变化甚至加重。
本文为全文原貌 未安装PDF浏览器用户请先下载安装 原版全文
1.4统计学方法
计数资料用χ2检验,采用SPSS13.0统计软件分析,P
2结果
2.1四组临床疗效比较
四组中只有HP-NSAIDs+组患者全部完全愈合,但由于该组病例较少,差异无统计学意义。四组之间完全愈合率比较差异无统计学意义(P>0.01)。但NSAIDs+和NSAIDs-组之间,NSAIDs+组70%患者达到了完全愈合,与NSAIDs-组35%达到完全愈合比较差异具有统计学意义(P
2.2不良反应
各组在第4周和第8周均无明显不良反应,肝肾功能及血尿便常规亦无异常变化。
3讨论
瑞巴派特作为一种胃黏膜保护药已经被广泛应用于临床治疗急性胃炎、消化性溃疡、以及NSAIDs和HP相关性溃疡[4,5]。目前研究已证实瑞巴派特能作用于表皮生长因子(EGF)及其受体环氧化酶-2(COX-2)和丝裂原激活蛋白(MAP)激酶信号途径前列腺素EP4受体、热休克蛋白的表达,核因子(NF)κB炎症信号转导途径,诱导型NO合酶(iNOS)mRNA的表达[6,7],从而清除激活的氧自由基,抑制中性粒细胞活化,升高表皮生长因子及其受体的表达,加强上皮屏障作用,刺激前列腺素生成,减少炎症因子的产生,激活COX-2的基因表达促进溃疡的愈合[7,8]。
本研究观察了瑞巴派特对HP感染同时伴或不伴NSAIDs相关性和无HP感染同时不伴NSAIDs相关性的患者愈合状况,结果显示瑞巴派特可以显著促进NSAIDs相关性患者的溃疡愈合。此外绝大部分患者对治疗效果满意且没有明显的不良反应及并发症。但是先前一些研究证明其有轻微的腹泻、呕吐、腹痛等不良反应,不过经证实没有严重不良反应且不会影响到患者安全[9,10]。
本研究结果表明瑞巴派特对NSAIDs相关性溃疡疗效显著,可以明显促进溃疡愈合并改善临床症状。不能证明瑞巴派特对HP相关性溃疡有良好疗效。因此HP相关性溃疡病例大样本量的研究,进一步证明瑞巴派特是否对其有明显疗效显的尤为重要。
[参考文献]
[1] Jeong SS,Kil HL,Soo TL,et al. Effect of rebamipide on chronic gastritis and peptic ulcer[D]. Jeonju South Korea: Institute of Medical Science,Chonbuk National University,1995,19(1).
[2] Watanabe K,Murakami K,Sato R,et al. Effect of sucralfate on antibiotic therapy for Helicobacter pylori infection in mice[J]. Antimicrob Agents Chemother,2004,48(12):4582-4588.
[3] Gaskina TK,Gorchakov VN,Mel'nikova EV. Effect of bioactive herbal preparations on structure of the gastric mucosa during stomach ulcer developing[J]. Morfologiia,2009,135(2):48-52.
[4] Arakawa T,Kobayashi K,Yoshikawa T,et al. Rebamipide:overview of its mechanisms of action and efficacy in mucosal protection and ulcer healing[J]. Dig Dis Sci,1998,43(9):5-13.
[5] Arakawa T,Higuchi K,Fujiwara Y,et al. 15th anniversary of rebamipide:looking ahead to the new mechanisms and new applications[J]. Dig Dis Sci,2005,50(1):3-11.
[6] Haruma K,Ito M. Review article:clinical significance of mucosal- protective agents:acid, inflammation,carcinogenesis and rebamipide[J]. Aliment Pharmacol Ther,2003,1:153-159.
[7] Naito Y,Kajikawa H,Mizushima K,et al. Rebamipide,a gastro -protective drug,inhibits indomethacin-induced apoptosis in cultured rat gastric mucosal cells:association with the inhibition of growth arrest and DNA damage-induced 45 alpha expression[J]. Dig Dis Sci,2005,1:104 -112.
[8] Sakurai K,Sasabe H,Koga T,et al. Mechanism of hydroxyl radical scavenging by rebamipide: identification of mono-hydroxylated rebamipide as a major reaction product[J]. Free Radic Res,2004,38(5):487-494.
[9] Fujioka T,Arakawa T,Shimoyama T,et al. Effects of rebamipide,a gastro-protective drug on the Helicobacter pylori status and inflammation in the gastric mucosa of patients with gastric ulcer:a randomized doubleblindplacebo-controlledmulticentretrial[J]. Aliment Pharmacol Ther,2003,18(1):146-152.
[10] Talley NJ,Riff DS,Schwartz H,et al. Double-blind placebo- controlled multicentre studies of rebamipide,a gastroprotective drug,in the treatment of functional dyspepsia with or without Helicobacter pylori infection[J]. Aliment Pharmacol Ther,2001,15:1603-1611.
(收稿日期:2010-01-13)
本文为全文原貌 未安装PDF浏览器用户请先下载安装 原版全文