药物使用与儿童上消化道并发症：病例对照研究。
Drug use and upper gastrointestinal complications in children: a case-control study.
机构信息
Regina Margherita Children’s Hospital, Turin, Italy.
出版信息
Arch Dis Child. 2013 Mar;98(3):218-21. doi: 10.1136/archdischild-2012-302100. Epub 2012 Dec 21.
OBJECTIVE
To evaluate the risk of upper gastrointestinal complications (UGIC) associated with drug use in the paediatric population.
METHODS
This study is part of a large Italian prospective multicentre study. The study population included children hospitalised for acute conditions through the emergency departments of eight clinical centres. Patients admitted for UGIC (defined as endoscopically confirmed gastroduodenal lesions or clinically defined haematemesis or melena) comprised the case series; children hospitalised for neurological disorders formed the control group. Information on drug and vaccine exposure was collected through parental interview during the children's hospitalisation. Logistic regression was used to estimate ORs for the occurrence of UGIC associated with drug use adjusted for age, clinical centre and concomitant use of any drug.
RESULTS
486 children hospitalised for UGIC and 1930 for neurological disorders were enrolled between November 1999 and November 2010. Drug use was higher in cases than in controls (73% vs 54%; p<0.001). UGICs were associated with the use of non-steroidal anti-inflammatory drugs (NSAIDs) (adjusted OR 2.9, 95% CI 2.1 to 4.0), oral steroids (adjusted OR 2.9, 95% CI 1.7 to 4.8) and antibiotics (adjusted OR 2.3, 95% CI 1.8 to 3.1). The duration of use of these drug categories was short (range 1-8 days). Paracetamol showed a lower risk (adjusted OR 2.0, 95% CI 1.5 to 2.6) compared to ibuprofen (adjusted OR 3.7, 95% CI 2.3 to 5.9), although with partially overlapping CIs.
CONCLUSIONS
NSAIDs, oral steroids and antibiotics, even when administered for a short period, were associated with an increased risk of UGIC.
目的
评估儿科人群中药物使用相关上消化道并发症（UGIC）的风险。
方法
本研究是意大利一项大型前瞻性多中心研究的一部分。研究人群包括通过 8 个临床中心的急诊部门住院治疗急性疾病的儿童。因 UGIC（定义为内镜证实的胃十二指肠病变或临床定义的呕血或黑便）住院的患者构成病例系列；因神经疾病住院的儿童构成对照组。通过儿童住院期间的父母访谈收集药物和疫苗暴露信息。使用逻辑回归估计与药物使用相关的 UGIC 发生的比值比（OR），并根据年龄、临床中心和任何药物的同时使用进行调整。
结果
1999 年 11 月至 2010 年 11 月期间，共纳入 486 例因 UGIC 和 1930 例因神经疾病住院的儿童。病例组的药物使用率高于对照组（73% vs 54%；p<0.001）。UGIC 与非甾体抗炎药（NSAIDs）（调整后 OR 2.9，95%CI 2.1 至 4.0）、口服类固醇（调整后 OR 2.9，95%CI 1.7 至 4.8）和抗生素（调整后 OR 2.3，95%CI 1.8 至 3.1）的使用相关。这些药物类别的使用时间较短（范围 1-8 天）。与布洛芬（调整后 OR 3.7，95%CI 2.3 至 5.9）相比，扑热息痛的风险较低（调整后 OR 2.0，95%CI 1.5 至 2.6），尽管两者的置信区间部分重叠。
结论
即使短期使用，NSAIDs、口服类固醇和抗生素也与 UGIC 风险增加相关。
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