兰索拉唑与罗沙替丁预防内镜黏膜下剥离术治疗胃浅表性肿瘤后出血和促进溃疡愈合的效果比较。
Effect of lansoprazole versus roxatidine on prevention of bleeding and promotion of ulcer healing after endoscopic submucosal dissection for superficial gastric neoplasia.
机构信息
Department of General Internal Medicine, Saitama Medical University, 38 Morohongo, Moroyama-machi, Iruma-gun, Saitama 350-0495, Japan.
出版信息
J Gastroenterol. 2011 Nov;46(11):1267-72. doi: 10.1007/s00535-011-0447-1. Epub 2011 Jul 30.
BACKGROUND
Proton pump inhibitors have been reported to be more useful than histamine-2 receptor antagonists for the prevention of bleeding after endoscopic submucosal dissection (ESD) for superficial gastric neoplasia. The aim of this study was to assess the effects of the proton pump inhibitor lansoprazole and the histamine-2 receptor antagonist roxatidine for the prevention of bleeding and the promotion of ulcer healing after ESD and to compare the cost-effectiveness of these two drugs.
METHODS
The study subjects were 129 patients who underwent ESD for superficial gastric neoplasia. The patients were randomly assigned to the lansoprazole group (L group) or the roxatidine group (R group). Either drug was administered intravenously from the morning of the ESD day to the day after the ESD, followed by oral treatment for an additional 8 weeks. A second-look endoscopy was performed on the day after the ESD, and a repeat endoscopy was performed at 8 weeks after the ESD. The incidence of bleeding and the ulcer-healing rate at 8 weeks after the ESD were analyzed, as well as the total cost of treatment with these antisecretory agents.
RESULTS
Three patients in each group were excluded from the analysis, leaving 62 patients in L group and 61 in R group. Two of the 62 patients (3.2%) in L group and three of the 61 patients (4.9%) in R group showed bleeding after ESD ; there was no significant difference between the two groups (P = 0.68). The ulcer-healing rate was 93.5% (58/62) in L group and 93.4% (57/61) in R group (P = 1). The total cost of treatment with the antisecretory agent from the day of the ESD to day 56 after the ESD was Yen 13,212 for lansoprazole and Yen 5,841 for roxatidine.
CONCLUSIONS
Roxatidine appears to have high cost-effectiveness in the prevention of bleeding and in the promotion of ulcer healing after ESD for superficial gastric neoplasia.
背景
质子泵抑制剂（PPI）在预防内镜黏膜下剥离术（ESD）治疗胃浅表性肿瘤后出血方面比组胺-2 受体拮抗剂更有效。本研究旨在评估质子泵抑制剂兰索拉唑和组胺-2 受体拮抗剂罗沙替丁预防 ESD 后出血和促进溃疡愈合的效果，并比较这两种药物的成本效益。
方法
本研究对象为 129 例接受 ESD 治疗的胃浅表性肿瘤患者。患者被随机分为兰索拉唑组（L 组）或罗沙替丁组（R 组）。两组患者均于 ESD 当天早上开始静脉内给药，至 ESD 后第 1 天，随后给予口服治疗 8 周。ESD 后第 1 天进行第 2 次内镜检查，并在 ESD 后 8 周进行复查。分析 ESD 后 8 周时出血的发生率和溃疡愈合率，以及这两种抗分泌剂的治疗总成本。
结果
每组各有 3 例患者被排除在分析之外，L 组 62 例，R 组 61 例。L 组中有 2 例（3.2%）和 R 组中有 3 例（4.9%）患者在 ESD 后出现出血，两组之间无显著差异（P=0.68）。L 组溃疡愈合率为 93.5%（58/62），R 组为 93.4%（57/61）（P=1）。从 ESD 日到 ESD 后第 56 天，抗分泌剂的治疗总成本，兰索拉唑为 13212 日元，罗沙替丁为 5841 日元。
结论
罗沙替丁在预防 ESD 治疗胃浅表性肿瘤后出血和促进溃疡愈合方面具有较高的成本效益。
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