Bianchi Porro G, Lazzaroni M, Petrillo M, Ardizzone S, Manzionna G, Caruso I, Montrone F
Department of Gastroenterology, L Sacco University Hospital, Milan, Italy.
Aliment Pharmacol Ther. 1998 Apr;12(4):343-7. doi: 10.1046/j.1365-2036.1998.00313.x.
To compare the efficacy of cimetidine and tripotassium dicitrato bismuthate (TDB) in arthritic patients who had developed gastric (GU) or duodenal (DU) ulceration while taking non-steroidal anti-inflammatory drugs (NSAIDs).
Eighty-six rheumatoid arthritis (RA) patients affected by endoscopically proven DU (n = 44) or GU (n = 42), and on chronic NSAID therapy which was not suspended during anti-ulcer therapy, were randomized to cimetidine (400 mg t.d.s.) or TDB (120 mg q.d.s.). A repeat endoscopy was planned after 4 weeks (and 8 weeks, in case of failed healing). The patients who were unhealed after 8 weeks of therapy were allocated to the alternative anti-ulcer drug for a further 8 weeks without interrupting the anti-inflammatory therapy.
At week 4 of therapy. 14/24 (58%) DU and 9/20 (45%) GU patients treated with cimetidine were healed, compared with 12/20 (60%) and 10/22 (45%) TDB-treated patients (N.S.). At week 8 of therapy, the DU healing rates were 15/24 (63%) with cimetidine and 14/20 (70%) for TDB. The corresponding GU healing rates were 12/20 (60%) with cimetidine and 13/22 (60%) for TDB (N.S.). At week 16, complete healing with cimetidine was observed in 67% of DU and 57% of GU patients unhealed with TDB; the corresponding figures in the patients crossed to TDB were 83% for DU and 63% for GU patients (N.S. vs. cimetidine).
No statistically significant difference was found between the healing activities of cimetidine and TDB in rheumatoid arthritis patients with peptic ulcer who did not interrupt their NSAID treatment for arthritis. This trial showed that the continued consumption of NSAIDs appears to slow the ulcer healing process, especially in GU patients.
比较西咪替丁和枸橼酸铋钾（TDB）对在服用非甾体抗炎药（NSAIDs）时发生胃溃疡（GU）或十二指肠溃疡（DU）的关节炎患者的疗效。
86例经内镜证实患有DU（n = 44）或GU（n = 42）的类风湿关节炎（RA）患者，正在接受慢性NSAID治疗且在抗溃疡治疗期间未停药，被随机分为西咪替丁组（400 mg，每日3次）或TDB组（120 mg，每日4次）。计划在4周后（如果愈合失败则在8周后）进行重复内镜检查。治疗8周后未愈合的患者被分配使用另一种抗溃疡药物再治疗8周，同时不中断抗炎治疗。
治疗第4周时，西咪替丁治疗的14/24（58%）例DU患者和9/20（45%）例GU患者愈合，而TDB治疗的患者分别为12/20（60%）例和10/22（45%）例（无统计学差异）。治疗第8周时，西咪替丁治疗的DU愈合率为15/24（63%），TDB治疗的为14/20（70%）。相应的GU愈合率，西咪替丁治疗的为12/20（60%），TDB治疗的为13/22（60%）（无统计学差异）。在第16周时，未被TDB治愈的DU患者中，67%的患者用西咪替丁实现完全愈合，GU患者为57%；转而接受TDB治疗的患者中，DU患者的相应数字为83%，GU患者为63%（与西咪替丁相比无统计学差异）。
在不中断关节炎NSAID治疗的消化性溃疡类风湿关节炎患者中，西咪替丁和TDB的愈合活性之间未发现统计学上的显著差异。该试验表明，持续服用NSAIDs似乎会延缓溃疡愈合过程，尤其是在GU患者中。
