Koch M, Capurso L, Dezi A, Ferrario F, Scarpignato C
Department of Gastroenterology, San Filippo Neri General Hospital, Rome, Italy.
Dig Dis. 1995 Jan;13 Suppl 1:62-74. doi: 10.1159/000171527.
In order to provide a systematic overview of the available information on the prevention of nonsteroidal anti-inflammatory drug (NSAID)-induced gastrointestinal mucosal injury, we performed a meta-analysis based on all the in extenso published randomized clinical trials comparing H2-blockers or misoprostol to placebo for the prevention of NSAID-induced gastrointestinal mucosal injury in arthritis patients or normal subjects. The main endpoints after NSAID therapy were considered the number of subjects developing gastric ulcer, or clinically relevant gastric lesions (i.e. more than 10 erosions or 1 ulcer), or duodenal ulcer, or clinically relevant duodenal lesions (i.e. more than 10 erosions or 1 ulcer). The total number of patients studied was 1,955, and that of normal subjects was 715. Results were analyzed by the DerSimonian and Laird method, as well as by the Peto one. The data available from the trials suggest that misoprostol prevention is of benefit in patients under NSAID treatment for the prevention of NSAID-induced gastroduodenal mucosal injury. The effect of prevention is statistically significant with both methods, and ranges from -42% (duodenal ulcer) to -79% (gastric ulcer). The prevention estimates for gastric and duodenal erosions are in between. H2-blockers seem to be less effective: prevention is not indeed demonstrable for the more relevant lesions, like gastric and duodenal ulcer.
为了系统综述关于预防非甾体抗炎药（NSAID）所致胃肠道黏膜损伤的现有信息，我们基于所有已全文发表的随机临床试验进行了一项荟萃分析，这些试验比较了H2受体阻滞剂或米索前列醇与安慰剂在关节炎患者或正常受试者中预防NSAID所致胃肠道黏膜损伤的效果。NSAID治疗后的主要终点包括发生胃溃疡、临床相关胃部病变（即10处以上糜烂或1处溃疡）、十二指肠溃疡或临床相关十二指肠病变（即10处以上糜烂或1处溃疡）的受试者数量。研究的患者总数为1955例，正常受试者为715例。结果采用DerSimonian和Laird法以及Peto法进行分析。试验可得数据表明，米索前列醇预防对于接受NSAID治疗的患者预防NSAID所致胃十二指肠黏膜损伤有益。两种方法的预防效果均具有统计学意义，范围从-42%（十二指肠溃疡）至-79%（胃溃疡）。胃和十二指肠糜烂的预防估计值介于两者之间。H2受体阻滞剂似乎效果较差：对于胃溃疡和十二指肠溃疡等更相关的病变，确实无法证实其预防作用。
