Choi Kee Don, Kim Nayoung, Jang In-Jin, Park Young Soo, Cho Joo Youn, Kim Jung-Ryul, Shin Jai Moo, Jung Hyun Chae, Song In Sung
Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
J Gastroenterol Hepatol. 2009 Oct;24(10):1617-24. doi: 10.1111/j.1440-1746.2009.05939.x. Epub 2009 Aug 3.
The lowest effective dose of proton pump inhibitors (PPI) for prevention of peptic ulcer rebleeding remains unclear. The objective of the present study was to evaluate whether low-dose PPI has a similar efficacy to high-dose i.v. administration for maintaining intragastric pH above 6.
Sixty-one patients with bleeding ulcers were randomized into one of three groups after endoscopic hemostasis: pantoprazole 80 mg bolus followed by 8 mg/h; 40 mg, 4 mg/h infusion; and bolus injection of 40 mg every 24 h. Intragastric pH values and rebleeding rates were measured. In addition, pharmacokinetic parameters and association with CYP2C19 polymorphisms and H. pylori infection were assessed.
Mean percentage of time with intragastric pH > 6, and the proportion of patients with pH > 6 for more than 60% of the time were significantly higher in the 40 mg, 4 mg/h infusion group compared to the 40 mg bolus injection. There was no significant difference between the 80 mg, 8 mg/h and the 40 mg, 4 mg/h groups. In the H. pylori (-) group, only 40% of patients that received continuous infusion reached the target pH > 6 for more than 60% of the time; this was significantly lower than the H. pylori (+) group, 87.5% (P = 0.026).
A continuous infusion, regardless of high or low dose, was more effective for acid suppression than a 40 mg bolus PPI injection in Korea. H. pylori infection was an important factor for the maintenance of an intragastric pH > 6.
预防消化性溃疡再出血的质子泵抑制剂（PPI）最低有效剂量尚不清楚。本研究的目的是评估低剂量PPI在维持胃内pH值高于6方面是否与高剂量静脉给药具有相似的疗效。
61例出血性溃疡患者在内镜止血后被随机分为三组之一：泮托拉唑80mg静脉推注，随后以8mg/h输注；40mg，4mg/h输注；以及每24小时静脉推注40mg。测量胃内pH值和再出血率。此外，评估药代动力学参数以及与CYP2C19基因多态性和幽门螺杆菌感染的相关性。
与40mg静脉推注组相比，40mg，4mg/h输注组胃内pH>6的平均时间百分比以及pH>6的时间超过60%的患者比例显著更高。80mg，8mg/h组与40mg，4mg/h组之间无显著差异。在幽门螺杆菌（-）组中，仅40%接受持续输注的患者胃内pH>6的时间超过60%；这显著低于幽门螺杆菌（+）组的87.5%（P=0.026）。
在韩国，无论高剂量还是低剂量，持续输注在抑制胃酸方面比40mg静脉推注PPI更有效。幽门螺杆菌感染是维持胃内pH>6的一个重要因素。
