阿根廷因消化性溃疡病住院的老年患者中非甾体抗炎药的暴露情况：一项病例对照研究。

Exposure to nonsteroidal anti-inflammatory drugs among older adult patients hospitalized for peptic ulcer disease in Argentina: A case-control study.

作者信息

Insúa Jorge, Mavros Panagiotis, Hunsche Elke, Kong Sheldon, Tibaudin-Agver Osvaldo

机构信息

Clinical Effectiveness Program, University of Buenos Aires School of Public Health/Hospital Italiano de Buenos Aires, Health Care Administration Program, Hospital Universitario Austral, Universidad Austral, Buenos Aires, Argentina.

出版信息

Am J Geriatr Pharmacother. 2006 Sep;4(3):251-9. doi: 10.1016/j.amjopharm.2006.09.008.

DOI:10.1016/j.amjopharm.2006.09.008

PMID:17062326

Abstract

OBJECTIVES

This study examined the association between exposure to nonselective NSAIDs and hospitalization for peptic ulcer disease (PUD) among older adults in Argentina.

METHODS

This was a case-control study based on the medical records of 5 hospitals in Buenos Aires. Cases were patients aged > or =50 years and hospitalized with PUD between 1997 and 2002 who were identified by mode of presentation (acute abdominal pain, vomiting, hematemesis, melena, shock, and asymptomatic anemia, or admission for an unknown reason and a discharge diagnosis related to upper gastrointestinal complications). Controls were hospitalized patients without PUD and were matched to cases (1:1) by age, sex, and admission date. NSAID exposure was defined as the use of NSAIDs during the year before admission. Conditional logistic regression analysis was used to examine the association between exposure to nonselective NSAIDs and hospitalizations for PUD, after adjusting for predictors. Subgroup analyses were conducted on patients with severe PUD, moderate PUD, and those whose PUD was confirmed by endoscopy.

RESULTS

The study included 324 cases and 324 matched controls. The mean patient age was 74 years. The discharge diagnoses indicated severe PUD in 46.3% (150/324), moderate PUD in 49.4% (160/324), and mild PUD in 4.3% (14/324) of cases. NSAID exposure was associated with an increased risk of hospitalization for PUD (odds ratio [OR], 5.20; 95% CI, 3.31-8.15). Risk was also increased for severe PUD (OR, 4.24; 95% CI, 2.29-7.87) and moderate PUD (OR, 6.08; 95% CI, 3.09-11.96). A history of upper gastrointestinal complications was independently associated with hospitalization for PUD (OR, 14.62; 95% CI, 6.70-31.91).

CONCLUSIONS

Use of nonselective NSAIDs is a significant risk factor for PUD-related hospitalizations among older adults in Argentina. The magnitude of the risk ratio resembles that reported for developed countries.

摘要

目的

本研究调查了阿根廷老年人使用非选择性非甾体抗炎药（NSAIDs）与因消化性溃疡病（PUD）住院之间的关联。

方法

这是一项基于布宜诺斯艾利斯5家医院病历的病例对照研究。病例为年龄≥50岁且在1997年至2002年间因PUD住院的患者，通过就诊方式（急性腹痛、呕吐、呕血、黑便、休克、无症状性贫血，或因不明原因入院且出院诊断与上消化道并发症相关）确定。对照为无PUD的住院患者，按年龄、性别和入院日期与病例进行1:1匹配。NSAID暴露定义为入院前一年使用NSAIDs。在调整预测因素后，使用条件逻辑回归分析来研究非选择性NSAIDs暴露与PUD住院之间的关联。对重度PUD患者、中度PUD患者以及PUD经内镜确诊的患者进行亚组分析。

结果

该研究纳入了324例病例和324例匹配对照。患者平均年龄为74岁。出院诊断显示，46.3%（150/324）的病例为重度PUD，49.4%（160/324）为中度PUD，4.3%（14/324）为轻度PUD。NSAID暴露与PUD住院风险增加相关（比值比[OR]，5.20；95%置信区间[CI]，3.31 - 8.15）。重度PUD（OR，4.24；95% CI，2.29 - 7.87）和中度PUD（OR，6.08；95% CI，3.09 - 11.96）的风险也增加。上消化道并发症病史与PUD住院独立相关（OR，14.62；95% CI，6.70 - 31.91）。