Armstrong D, Arnold R, Classen M, Fischer M, Goebell H, Blum A L
Division of Gastroenterology, CHUV/PMU, Lausanne, Switzerland.
Gut. 1993 Oct;34(10):1319-26. doi: 10.1136/gut.34.10.1319.
Risk factors for delayed duodenal ulcer healing during treatment with ranitidine (300 mg daily) were examined in a multicentre German study of 1923 patients with endoscopically proved, recurrent duodenal ulceration. Healing rates, per protocol, were 39.5% at two weeks, 70.9% at four weeks, and 93.2% at eight weeks. Prospective testing of five, predefined risk factors indicated that smoking (p = 0.0039) was associated with a decreased healing rate at two weeks. Frequent prior recurrence (p = 0.464), a heavy physical workload (p = 0.145), and psychological stress (p = 0.062) were not associated with a decreased healing rate and there were too few patients at risk to allow assessment of the effect of regular NSAID intake. Exploratory analysis identified prior slow healing, a large ulcer, multiple ulcers, and prior ulcer complications, in addition to smoking, as markers of slow healing. In the absence of these risk factors, the mean healing time was 3.3 weeks (95% confidence interval 3.0, 3.5), rising to 3.7 weeks (3.5, 3.9) for one, 4.4 weeks (4.1, 4.7) for two, and 5.1 weeks (4.5, 5.6) for three to five risk factors. Delayed duodenal ulcer healing is associated with multiple factors whose effect is cumulative; for patients with two or more of five easily identified risk factors, more than four weeks' treatment with a histamine H2 receptor antagonist is required to achieve ulcer healing.
在一项针对1923例经内镜证实为复发性十二指肠溃疡的德国多中心研究中，对雷尼替丁（每日300毫克）治疗期间十二指肠溃疡愈合延迟的危险因素进行了研究。按照方案，两周时愈合率为39.5%，四周时为70.9%，八周时为93.2%。对五个预先定义的危险因素进行的前瞻性测试表明，吸烟（p = 0.0039）与两周时愈合率降低有关。既往频繁复发（p = 0.464）、繁重的体力工作负荷（p = 0.145）和心理压力（p = 0.062）与愈合率降低无关，且处于风险中的患者太少，无法评估规律服用非甾体抗炎药的影响。探索性分析确定，除吸烟外，既往愈合缓慢、溃疡面积大、多发溃疡和既往溃疡并发症是愈合缓慢的标志。在没有这些危险因素的情况下，平均愈合时间为3.3周（95%置信区间3.0，3.5），有一个危险因素时升至3.7周（3.5，3.9），有两个危险因素时为4.4周（4.1，4.7），有三到五个危险因素时为5.1周（4.5，5.6）。十二指肠溃疡愈合延迟与多种因素相关，这些因素的影响是累积性的；对于有五个易于识别的危险因素中的两个或更多的患者，需要用组胺H2受体拮抗剂治疗超过四周才能实现溃疡愈合。
