NSAIDsNSAIDs相关性胃粘膜损伤的防治相关性胃粘膜损伤的防治——抑酸还是胃粘膜保护？抑酸还是胃粘膜保护？吴斌吴斌中山大学附属第三医院消化科中山大学附属第三医院消化科DivisionofDivisionofGI,GI,DepartmentofMedicineDepartmentofMedicineBrighamandWomen’sHospitalBrighamandWomen’sHospitalHarvardMedicalSchoolHarvardMedicalSchool1.1.NSAIDsNSAIDs的临床使用情况。的临床使用情况。2.2.NSAIDsNSAIDs相关性胃肠粘膜损伤。相关性胃肠粘膜损伤。3.3.NSAIDsNSAIDs相关性胃肠粘膜损伤的防相关性胃肠粘膜损伤的防治—抑酸还是胃粘膜保护？治—抑酸还是胃粘膜保护？阿司匹林阿司匹林与胃粘膜糜烂与胃粘膜糜烂急性急性(1-2(1-2周周)/)/慢性慢性(4-6(4-6周周))黏膜损伤：胃窦和胃体部黏膜损伤：胃窦和胃体部黏膜瘀点、红斑、黏膜下出血、糜烂黏膜瘀点、红斑、黏膜下出血、糜烂阿司匹林服用后阿司匹林服用后15-30min15-30min内可出现急性胃粘膜损伤内可出现急性胃粘膜损伤AalykkeC,LauritsenK.BestPractice&ResearchClinicalGastroenterology.2001;15(5):705-22.4NSAIDs-InduceGINSAIDs-InduceGIinjuriesinjuriesNSAID-RelatedGastrointestinalComplications=NNSAID-RelatedGastrointestinalComplications=NSAID-InduceGIinjuriesSAID-InduceGIinjuries临床疾病谱临床疾病谱–胃、十二指肠粘膜损伤（胃、十二指肠粘膜损伤（UGIEUGIE））–肠粘膜损伤肠粘膜损伤小肠小肠大肠大肠胃肠道安全性是NSAID的百年难题5NSAIDsNSAIDs相关相关UGIE—UGIE—临床临床特点特点内镜下胃粘膜损伤程度与临床症状相关性差内镜下胃粘膜损伤程度与临床症状相关性差–无症状或无痛无症状或无痛15~36%15~36%–多无预警症状，以并发症起病多无预警症状，以并发症起病58%58%–低剂量低剂量ASAASA无消化道症状无消化道症状志愿者内镜检查志愿者内镜检查发现糜烂或溃疡病变占发现糜烂或溃疡病变占48%48%6Non-NSAIDsAspiringNSAID77%9%14%235例活动期PU心血管疾病52.4%脑血管疾病42.6%心血管疾病52.4%脑血管疾病42.6%JapanMizogami.H2004Arthritis53%，RA15.6%commoncold6.3%headache6.3%abd.pain6.3%非甾体类抗炎药（（Non-SteroidAnti-InflammtoryDrugs.NNon-SteroidAnti-InflammtoryDrugs.NSAIDSAIDSS))应用广泛。用应用广泛。用量量仅次于抗菌素、维仅次于抗菌素、维生素的第三大类药生素的第三大类药NSAIDsNSAIDs的作用的作用NSAIDNSAIDss除抑制前...
