van Soest E M, Sturkenboom M C J M, Dieleman J P, Verhamme K M C, Siersema P D, Kuipers E J
Department of Gastroenterology and Hepatology, Erasmus MC - University Medical Center, Rotterdam, The Netherlands.
Aliment Pharmacol Ther. 2007 Jul 15;26(2):265-75. doi: 10.1111/j.1365-2036.2007.03358.x.
Upper gastrointestinal (UGI) complications are a well-recognized risk of NSAID treatment, requiring preventive measures in high-risk patients. Adherence to gastroprotective agents (GPAs) in NSAID users has been suggested to be suboptimal.
To investigate the association between adherence to GPAs (proton pump inhibitors or H(2)-receptor antagonists) and the risk of NSAID-related UGI ulcers or haemorrhage in high-risk patients.
A population-based nested case-control study was conducted within a cohort of new NSAID users with at least one risk factor for a NSAID-related UGI complication, identified in the Dutch IPCI database during 1996-2005. Adherence to GPAs was calculated as the proportion of NSAID treatment days covered (PDC) by a GPA prescription. Multivariate conditional logistic regression analysis was used to calculate odds ratios with 95% confidence intervals (95% CI).
Fifteen percent of the non-selective NSAID users received GPAs. The risk of a NSAID-related UGI complication among NSAID users increased 16% for every 10% decrease in adherence. Compared to patients with a PDC of >80%, patients with PDCs of 20-80% and <20% had a 2.5-fold (95% CI: 1.0-6.7) respectively 4.0-fold (95% CI: 1.2-13.0) increased risk.
There is a strong inverse relationship between adherence to GPAs and the risk of UGI complications in high-risk NSAID users.
上消化道（UGI）并发症是公认的非甾体抗炎药（NSAID）治疗风险，高危患者需要采取预防措施。有研究表明，NSAID使用者对胃保护剂（GPA）的依从性欠佳。
探讨高危患者对GPA（质子泵抑制剂或H₂受体拮抗剂）的依从性与NSAID相关UGI溃疡或出血风险之间的关联。
在1996年至2005年期间于荷兰IPCI数据库中识别出的至少有一项NSAID相关UGI并发症风险因素的新NSAID使用者队列中，开展了一项基于人群的巢式病例对照研究。GPA依从性通过GPA处方覆盖的NSAID治疗天数比例（PDC）来计算。采用多变量条件逻辑回归分析计算比值比及95%置信区间（95%CI）。
15%的非选择性NSAID使用者接受了GPA治疗。NSAID使用者中，依从性每降低10%，NSAID相关UGI并发症风险增加16%。与PDC>80%的患者相比，PDC为20%-80%和<20%的患者风险分别增加2.5倍（95%CI：1.0-6.7）和4.0倍（95%CI：1.2-13.0）。
高危NSAID使用者对GPA的依从性与UGI并发症风险之间存在强烈的负相关关系。
