Department of Internal Medicine, Kawasaki Medical School, Kurashiki City, Okayama Prefecture, Japan.
J Gastroenterol Hepatol. 2012 Apr;27 Suppl 3:8-12. doi: 10.1111/j.1440-1746.2012.07071.x.
The risk of peptic ulcer complications, particularly bleeding, is increased in association with the use of low-dose aspirin (LDA). Risk factors for upper gastrointestinal (GI) ulcer or bleeding among LDA users include a history of prior GI events, older age, chronic renal failure, combined antithrombotic therapy and nonsteroidal anti-inflammatory drugs (NSAIDs). Helicobacter pylori and aspirin seem to be independent risk factors for peptic ulcer and bleeding. The studies report conflicting findings about the effect of H. pylori infection on NSAID-related ulcers, and proton-pump inhibitors (PPIs) seem to be superior to eradication only to prevent recurrent ulcer bleeding with LDA. Previous studies indicate that hypoacidity related to corpus atrophy, as well as taking PPIs and co-treatment with angiotensin type 1 receptor blockers (ARBs) and statins seem to reduce peptic ulcer among LDA users. In addition, the interleukin-1β (IL-1β)-511 T allele and angiotensinogen (AGT)-20 CC, which work as the high-producer allele of IL-1β and AGT, are significantly associated with ulcer or ulcer bleeding. The SLCO1B1*1b haplotype, which has the highest transport activity, may diminish the preventive effect of statins or ARBs. The data are still lacking and further prospective studies are needed to identify the specific risk or protective factors for upper GI ulcer and its complications associated with LDA.
低剂量阿司匹林（LDA）会增加消化性溃疡并发症（尤其是出血）的风险。LDA 使用者发生上消化道（GI）溃疡或出血的危险因素包括既往 GI 事件史、年龄较大、慢性肾衰竭、联合抗血栓治疗和非甾体抗炎药（NSAIDs）。幽门螺杆菌和阿司匹林似乎是消化性溃疡和出血的独立危险因素。这些研究报告了关于 H. pylori 感染对 NSAID 相关溃疡影响的相互矛盾的结果，质子泵抑制剂（PPIs）似乎优于根除治疗，仅能预防 LDA 相关复发性溃疡出血。先前的研究表明，与胃体萎缩相关的低酸度，以及使用 PPIs 以及与血管紧张素 1 型受体阻滞剂（ARBs）和他汀类药物的联合治疗，似乎会降低 LDA 使用者的消化性溃疡风险。此外，白细胞介素-1β（IL-1β）-511 T 等位基因和血管紧张素原（AGT）-20 CC，作为 IL-1β 和 AGT 的高产生等位基因，与溃疡或溃疡出血显著相关。具有最高转运活性的 SLCO1B1*1b 单倍型可能会降低他汀类药物或 ARBs 的预防作用。目前数据仍然缺乏，需要进一步的前瞻性研究来确定与 LDA 相关的上消化道溃疡及其并发症的特定风险或保护因素。
