Kaufman D W, Kelly J P, Sheehan J E, Laszlo A, Wiholm B E, Alfredsson L, Koff R S, Shapiro S
Slone Epidemiology Unit, School of Public Health, Boston University School of Medicine, Brookline, Mass.
Clin Pharmacol Ther. 1993 Apr;53(4):485-94. doi: 10.1038/clpt.1993.55.
In a study in the United States, Sweden, and Hungary, 335 cases of gastric bleeding without predisposing factors were compared with 670 control subjects, and 239 cases of duodenal bleeding were compared with 489 control subjects. For aspirin taken at least every other day during the week before the onset of bleeding (regular use), the relative risk of gastric bleeding was 4.4 (95% confidence interval [CI], 2.9 to 6.7); for occasional use, it was 3.3 (95% CI, 2.1 to 5.0). For ibuprofen, the corresponding estimates were 1.0 (95% CI, 0.4 to 2.6) and 1.1 (95% CI, 0.5 to 2.4). For naproxen, the estimate for regular use was 4.0 (95% CI, 1.5 to 11). The estimates for any use of piroxicam (crude estimate), indomethacin, and diclofenac during the week before onset were 18 (95% CI, 4.1 to 83), 1.6 (95% CI, 0.4 to 5.9), and 0.9 (95% CI, 0.2 to 4.2), respectively. The corresponding relative risks of duodenal bleeding were 7.1 (95% CI, 4.2 to 12) and 2.2 (95% CI, 1.3 to 3.7) for the regular and occasional use of aspirin, 2.4 (95% CI, 0.5 to 11) and 0.8 (95% CI, 0.3 to 2.0) for ibuprofen, 12 (95% CI, 2.8 to 54) and 9.9 (95% CI, 2.3 to 44) for naproxen, 17 (95% CI, 3.6 to 79) for any use of piroxicam (crude estimate), and 1.7 (95% CI, 0.2 to 14) for any use of indomethacin. There was a significant trend in the risk of gastric bleeding with increasing dose of regular aspirin use (p = 0.002). The relative risk estimates for the regular use of 325 mg or less were significantly elevated for both gastric and duodenal bleeding at 3.1 and 6.4, respectively.
在美国、瑞典和匈牙利开展的一项研究中，将335例无诱发因素的胃出血病例与670名对照对象进行了比较，并将239例十二指肠出血病例与489名对照对象进行了比较。对于在出血发作前一周内至少每隔一天服用一次阿司匹林（规律使用）的情况，胃出血的相对风险为4.4（95%置信区间[CI]，2.9至6.7）；对于偶尔使用，相对风险为3.3（95%CI，2.1至5.0）。对于布洛芬，相应的估计值分别为1.0（95%CI，0.4至2.6）和1.1（95%CI，0.5至2.4）。对于萘普生，规律使用的估计值为4.0（95%CI，1.5至11）。在发作前一周内使用吡罗昔康（粗略估计）、吲哚美辛和双氯芬酸的任何情况的估计值分别为18（95%CI，4.1至83）、1.6（95%CI，0.4至5.9）和0.9（95%CI，0.2至4.2）。阿司匹林规律使用和偶尔使用时，十二指肠出血的相应相对风险分别为7.1（95%CI，4.2至12）和2.2（95%CI，1.3至3.7）；布洛芬的相应值分别为2.4（95%CI，0.5至11）和0.8（95%CI，0.3至2.0）；萘普生的相应值分别为12（95%CI，2.8至54）和9.9（95%CI，2.3至44）；使用吡罗昔康（粗略估计）的任何情况的相对风险为17（95%CI，3.6至79）；使用吲哚美辛的任何情况的相对风险为1.7（95%CI，0.2至14）。随着规律使用阿司匹林剂量的增加，胃出血风险存在显著趋势（p = 0.002）。规律使用325毫克或更低剂量阿司匹林时，胃出血和十二指肠出血的相对风险估计值均显著升高，分别为3.1和6.4。
