Pantea Monica, Negovan Anca, Voidăzan Septimiu, Macarie Melania, Mocan Simona, Băţagă Simona
University of Medicine and Pharmacy, Clinical Science-Internal Medicine.
University of Medicine and Pharmacy, Functional and Additional Science.
Medicine (Baltimore). 2018 Dec;97(50):e13579. doi: 10.1097/MD.0000000000013579.
Experimental studies showed a dose-dependent gastroprotective effect of statins on non-steroidal anti-inflammatory drug-induced endoscopic lesions, modulated by increasing endogenous nitric oxide and prostaglandin production.We investigated the influence of chronic treatment with statins on the occurrence of endoscopic lesions in patients referred for endoscopic evaluation, adjusted for the most important etiologic and risk factors for peptic ulcer disease and its complications.A consecutive series of 564 patients who underwent upper digestive endoscopy, stratified according to the severity of endoscopic lesions were recruited. Patients with statin therapy were included in the study group (n = 220), while patients without statins in the control group (n = 344). We correlate the influence of chronic statin therapy (at least 6 months) with factors including age up to 50 years, Helicobacter pylori infection, smoking and drinking habits, ulcer history, gastrotoxic drug consumption (low-dose aspirin [ASA], anticoagulants), and comorbidities.H pylori infection was more frequent in patients with mild/severe endoscopic lesions vs. no lesions, in both groups, but the difference was not statistically significant (P >.05). Male gender represented a risk factor (P <.01) for mild/severe endoscopic lesions only in the statin group. The estimated risk for developing mild/severe endoscopic lesions with ASA intake decreased from 6.26 to 3.40 (P <.01) when statin therapy was associated. Patients without statins and ischemic coronary artery disease (P <.01; odds ratio [OR] = 2.99; 95% confidence interval (CI):1.88-4.73), heart failure (P = .01; OR = 2.13; 95% CI:1.36-3.34), systemic atherosclerosis (P = .04; OR = 2.30; 95% CI:1.44-3.67) had a statistically significant increased risk for developing mild/severe endoscopic lesions in comparison with patients in the statin group. In multivariate regression analysis models, smoking (P <.01; OR = 2.69; 95% CI:1.73-4.16), ASA (P <.01; OR = 4.54; 95% CI:2.83-7.16), and coronary artery diseases (P = .01; OR = 1.80; 95% CI:1.15-2.82) were independent risk factors for mild/severe endoscopic lesions, while chronic statin therapy (P <.01; OR = 0.31; 95% CI:0.19-0.51) was associated with a protective effect in all models.The results of the present study support a certain protective role of chronic therapy with statins against endoscopic lesions, especially in ASA consumers or patients with cardiovascular diseases.
实验研究表明，他汀类药物对非甾体抗炎药引起的内镜下病变具有剂量依赖性的胃保护作用，这种作用通过增加内源性一氧化氮和前列腺素的产生来调节。我们研究了他汀类药物长期治疗对因内镜评估而转诊的患者内镜下病变发生情况的影响，并对消化性溃疡疾病及其并发症的最重要病因和危险因素进行了校正。招募了连续的564例行上消化道内镜检查的患者，并根据内镜下病变的严重程度进行分层。接受他汀类药物治疗的患者纳入研究组（n = 220），未接受他汀类药物治疗的患者纳入对照组（n = 344）。我们将他汀类药物长期治疗（至少6个月）的影响与年龄在50岁以下、幽门螺杆菌感染、吸烟和饮酒习惯、溃疡病史、胃毒性药物使用（低剂量阿司匹林[ASA]、抗凝剂）以及合并症等因素相关联。在两组中，轻度/重度内镜下病变患者的幽门螺杆菌感染均比无病变患者更常见，但差异无统计学意义（P>0.05）。仅在他汀类药物组中，男性是轻度/重度内镜下病变的危险因素（P<0.01）。当联合他汀类药物治疗时，服用ASA发生轻度/重度内镜下病变的估计风险从6.26降至3.40（P<0.01）。未服用他汀类药物且患有缺血性冠状动脉疾病（P<0.01；比值比[OR]=2.99；95%置信区间（CI）：1.88 - 4.73）、心力衰竭（P = 0.01；OR = 2.13；95%CI：1.36 - 3.34）、全身性动脉粥样硬化（P = 0.04；OR = 2.30；95%CI：1.44 - 3.67）的患者与他汀类药物组患者相比，发生轻度/重度内镜下病变的风险有统计学意义的增加。在多变量回归分析模型中，吸烟（P<0.01；OR = 2.69；95%CI：1.73 - 4.16）、ASA（P<0.01；OR = 4.54；95%CI：2.83 - 7.16）和冠状动脉疾病（P = 0.01；OR = 1.80；95%CI：1.15 - 2.82）是轻度/重度内镜下病变的独立危险因素，而他汀类药物长期治疗（P<0.01；OR = 0.31；95%CI：0.19 - 0.51）在所有模型中均具有保护作用。本研究结果支持他汀类药物长期治疗对内镜下病变具有一定的保护作用，尤其是在服用ASA的患者或患有心血管疾病的患者中。
