Burget D W, Chiverton S G, Hunt R H
Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
Gastroenterology. 1990 Aug;99(2):345-51. doi: 10.1016/0016-5085(90)91015-x.
The optimal degree and duration of suppression of gastric acidity required for the healing of peptic ulcers has never been established. Although very potent inhibitors of acid secretion are now available, the need for this degree of suppression has not been shown, and there is a possibility of adverse effects because of pronounced acid inhibition. Therefore, a model has been constructed that defines the relationship between duodenal ulcer healing and antisecretory therapy. Acid suppression data were obtained directly from investigators as raw data from 24-hour studies of acid secretion. Twenty-one experiments from seven investigators provided 490 24-hour studies using 19 different treatment regimens. Healing data were collected from a metaanalysis of published clinical trials of duodenal ulcer healing. A total of 144 published trials in 14,208 patients provided healing data at several endoscopic endpoints for the 19 drug regimens for which acidity data were provided. Weighted least-squares polynomial regression analysis was used to define those parameters of antisecretory therapy that contributed most to duodenal ulcer healing and to define the shape of the response surface. A highly significant correlation (r = 0.9814) was found between healing and the degree of acid suppression, the duration of acid suppression, and the length of therapy. The shape of the contour expression this relationship shows that healing increases as the duration of suppression increases and as gastric pH increases. However, suppression that increased pH beyond 3.0 was not found to increase ulcer healing further. It is concluded that a longer duration of antisecretory effect and/or a longer duration of therapy are of greater importance than potency for duodenal ulcer healing.
消化性溃疡愈合所需胃酸抑制的最佳程度和持续时间尚未确定。尽管现在已有非常强效的胃酸分泌抑制剂，但尚未证明需要达到这种抑制程度，而且由于明显的胃酸抑制可能会产生不良反应。因此，构建了一个模型来定义十二指肠溃疡愈合与抗分泌治疗之间的关系。胃酸抑制数据直接从研究人员处获得，作为24小时胃酸分泌研究的原始数据。来自7位研究人员的21项实验提供了490项使用19种不同治疗方案的24小时研究。愈合数据是从已发表的十二指肠溃疡愈合临床试验的荟萃分析中收集的。在14208名患者中进行的总共144项已发表试验，针对提供了胃酸度数据的19种药物治疗方案，在几个内镜终点提供了愈合数据。采用加权最小二乘多项式回归分析来确定抗分泌治疗中对十二指肠溃疡愈合贡献最大的参数，并确定反应面的形状。发现愈合与胃酸抑制程度、胃酸抑制持续时间和治疗时长之间存在高度显著的相关性（r = 0.9814）。表示这种关系的等高线形状表明，随着抑制持续时间的增加和胃pH值的升高，愈合率增加。然而，未发现将pH值提高到3.0以上的抑制作用会进一步增加溃疡愈合率。结论是，对于十二指肠溃疡愈合而言，抗分泌作用的持续时间更长和/或治疗时长更长比效力更重要。
