Haruma K, Ito M
Division of Gastroenterology, Department of Internal Medicine, Kawasaki Medical School, Kurashiki, Japan.
Aliment Pharmacol Ther. 2003 Jul;18 Suppl 1:153-9. doi: 10.1046/j.1365-2036.18.s1.17.x.
While a great deal of clinical evidence has been found regarding anti-acids for the treatment of gastric disorders including peptic ulcers, not all disorders can be explained only by the hyperfunction of acid secretion. Especially in the Asian region, glandular atrophy is more prominent than in Western countries, therefore low acid output is often observed in these patients. Improvement of mucosal protection is rational therapy for these patients; this is the reason for use of these agents in Asian countries. Rebamipide has many biological activities for gastric mucosa such as increasing the blood flow and biosynthesis prostaglandins and the decrease of oxygen radicals. These suggest the possible efficacy of rebamipide in the prevention of both Helicobacter pylori-related and nonsteroidal anti-inflammatory drug (NSAID)-induced gastric injury, which has been proved by human studies. Rebamipide is the only mucosal-protective drug which can improve the histological gastritis in vivo, whereas anti-acids have a lesser effect in influencing gastritis. Improvement of gastritis is expressed not only in quantity but also in quality of gastritis, which is shown as the reduction of iNOS expression in the gastric mucosa. Clinically, it is suggested that rebamipide has the potential to prevent gastric carcinogenesis by improvement of histological gastritis.
虽然已经发现了大量关于抗酸剂治疗包括消化性溃疡在内的胃部疾病的临床证据，但并非所有疾病都仅由胃酸分泌过多来解释。特别是在亚洲地区，腺体萎缩比西方国家更为突出，因此这些患者常出现胃酸分泌减少的情况。改善黏膜保护对这些患者来说是合理的治疗方法；这就是这些药物在亚洲国家使用的原因。瑞巴派特对胃黏膜具有多种生物学活性，如增加血流量、生物合成前列腺素以及减少氧自由基。这些表明瑞巴派特在预防幽门螺杆菌相关和非甾体抗炎药（NSAID）引起的胃损伤方面可能具有疗效，这已得到人体研究的证实。瑞巴派特是唯一一种能在体内改善组织学胃炎的黏膜保护药物，而抗酸剂对胃炎的影响较小。胃炎的改善不仅体现在数量上，还体现在胃炎的质量上，这表现为胃黏膜中诱导型一氧化氮合酶（iNOS）表达的降低。临床上，提示瑞巴派特有可能通过改善组织学胃炎来预防胃癌发生。
