Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts, USA.
Gastroenterology. 2011 Jul;141(1):71-9. doi: 10.1053/j.gastro.2011.03.049. Epub 2011 Mar 31.
BACKGROUND & AIMS: We investigated the effect of different prevention strategies against upper gastrointestinal bleeding (UGIB) in the general population and in patients on antithrombotic or anti-inflammatory treatments.
We performed a population-based, nested, case-control study using The Health Improvement Network UK primary care database. From 2000 to 2007, we identified 2049 cases of UGIB and 20,000 controls. The relative risk (RR) of UGIB associated with various gastroprotective agents was estimated by comparing current use (defined as use within 30 days of the index date) with nonuse in the previous year, using multivariate logistic regression.
The adjusted RR of UGIB associated with current use of proton pump inhibitors (PPIs) for more than 1 month was 0.58 (95% confidence interval [CI], 0.42-0.79) among patients who received low-dose acetylsalicylic acid (ASA), 0.18 (95% CI, 0.04-0.79) for clopidogrel, 0.17 (95% CI, 0.04-0.76) for dual antiplatelet therapy, 0.48 (95% CI, 0.22-1.04) for warfarin, and 0.51 (95% CI, 0.34-0.78) for nonsteroidal anti-inflammatory drugs. The corresponding estimates for therapy with histamine-2-receptor antagonists (H2RAs) were more unstable, but tended to be of a smaller magnitude. In the general population, PPI use was associated with a reduced risk of UGIB compared with nonuse (RR, 0.80; 95% CI, 0.68-0.94); no such reduction was observed for H2RAs or nitrates.
PPI use was associated with a lower risk of UGIB in the general population and in patients on antithrombotic or anti-inflammatory therapy compared with nonuse of PPIs. The reduction in risks of UGIB was smaller in H2RA than in PPI users.
本研究旨在调查针对普通人群和接受抗血栓或抗炎治疗的患者，不同上消化道出血（UGIB）预防策略的效果。
我们采用英国医疗改进网络初级保健数据库进行了一项基于人群的嵌套病例对照研究。在 2000 年至 2007 年期间，我们共确定了 2049 例 UGIB 患者和 20000 例对照者。通过比较当前使用（定义为在索引日期前 30 天内使用）与前一年未使用的情况，使用多变量逻辑回归估计各种胃保护剂与 UGIB 相关的相对风险（RR）。
与小剂量乙酰水杨酸（ASA）相比，接受低剂量 ASA 的患者中，当前使用质子泵抑制剂（PPIs）超过 1 个月的 UGIB 调整 RR 为 0.58（95%置信区间[CI]，0.42-0.79），氯吡格雷为 0.18（95%CI，0.04-0.79），双联抗血小板治疗为 0.17（95%CI，0.04-0.76），华法林为 0.48（95%CI，0.22-1.04），而非甾体抗炎药为 0.51（95%CI，0.34-0.78）。接受组胺 2 受体拮抗剂（H2RAs）治疗的估计值则更不稳定，但倾向于幅度较小。在普通人群中，与未使用者相比，PPIs 的使用与 UGIB 风险降低相关（RR，0.80；95%CI，0.68-0.94）；而 H2RAs 或硝酸盐则无此效果。
与未使用 PPI 相比，在普通人群和接受抗血栓或抗炎治疗的患者中，PPIs 的使用与 UGIB 风险降低相关。H2RA 使用者的 UGIB 风险降低幅度小于 PPI 使用者。
