Institute of Digestive Disease, Chinese University of Hong Kong, Hong Kong, SAR, China.
Clin Gastroenterol Hepatol. 2012 Oct;10(10):1124-9. doi: 10.1016/j.cgh.2012.06.012. Epub 2012 Jun 23.
BACKGROUND & AIMS: We performed a prospective cohort study to investigate the effects of gastroprotective agents (such as proton pump inhibitors or histamine-2 receptor antagonists) on long-term clinical outcomes of patients with Helicobacter pylori-negative idiopathic bleeding ulcers.
Patients with H pylori-negative idiopathic bleeding ulcers were recruited from a single center from April 2002 to March 2009 (n = 663). Age- and sex-matched patients with H pylori-positive bleeding ulcers were used as controls (n = 633). After ulcers had healed, 566 patients in the H pylori-negative idiopathic ulcer cohort received gastroprotective agents at clinicians' discretion, whereas controls received no gastroprotective agent after H pylori eradication therapy. Patients were followed until September 2011 for end points that included recurrent ulcer bleeding and all-cause mortality.
During the exposed period of 534 person-years, the incidence rates of recurrent ulcer bleeding and death were 3.8 (95% confidence interval [CI], 2.6-5.4) and 21.8 (95% CI, 18.8-25.3) per 100 person-years among the patients given gastroprotective agents, compared with incidence rates of 2.4 (95% CI, 1.6-3.5; P = .08) and 13.8 (95% CI, 11.9-16.0; P < .001) per 100 person-years, respectively, during the unexposed period of 1588 person-years. Use of gastroprotective agents was not associated with mortality, after adjusting for confounders (hazard ratio, 1.1; 95% CI, 0.6-1.7). Incident rates of recurrent ulcer bleeding and death were significantly higher in patients with H pylori-negative idiopathic ulcers (2.9 and 17.0 per 100 person-years, respectively) than in controls (1.1 and 5.9 per 100 person-years, respectively; P < .001).
Gastroprotective agents do not reduce the risk of recurrent bleeding or mortality for patients with H pylori-negative idiopathic bleeding ulcers.
我们进行了一项前瞻性队列研究，旨在探讨胃保护剂（如质子泵抑制剂或组胺 2 受体拮抗剂）对 Hp 阴性特发性出血性溃疡患者长期临床结局的影响。
我们于 2002 年 4 月至 2009 年 3 月从一家中心招募了 Hp 阴性特发性出血性溃疡患者（n=663）。与 Hp 阳性出血性溃疡患者（n=633）进行年龄和性别匹配。溃疡愈合后，在 Hp 阴性特发性溃疡队列中，566 例患者根据临床医生的判断接受了胃保护剂，而对照组在 Hp 根除治疗后未接受胃保护剂。患者随访至 2011 年 9 月，终点事件包括复发性溃疡出血和全因死亡率。
在 534 人年的暴露期间，接受胃保护剂的患者复发性溃疡出血和死亡的发生率分别为 3.8（95%可信区间[CI]，2.6-5.4）和 21.8（95% CI，18.8-25.3）/100 人年，而在未暴露于 1588 人年的情况下，发生率分别为 2.4（95% CI，1.6-3.5；P=0.08）和 13.8（95% CI，11.9-16.0；P<.001）/100 人年。调整混杂因素后，使用胃保护剂与死亡率无关（风险比，1.1；95% CI，0.6-1.7）。Hp 阴性特发性溃疡患者复发性溃疡出血和死亡的发生率明显高于对照组（分别为 2.9 和 17.0/100 人年和 1.1 和 5.9/100 人年；P<.001）。
胃保护剂不能降低 Hp 阴性特发性出血性溃疡患者复发性出血或死亡的风险。
