美国胃肠病常务理事（AGA）有关开据 NSAIDs处方的建议

酮类类阿司匹林的运用于在在高发肾脏胃癌学术界委员会合意草拟推荐拟议来下降后果据美国消化道联合国开发计划署时会召集的交叉学时医学术界委员会介绍，酮类类阿司匹林给有化学时疗法的病变提供了广阔的更进一步，但是医疗其他部门在给患者开据这镇静剂前所，必须仔细考虑它的在在后果。肾脏病变是用作非类阿司匹林的最类似于的不良底物，最主要上肠胃和下肠胃的胃癌。更为严重的肾脏胃癌，如潜在的致命性囊肿性溃疡，年感染率为用作者的1－4％。学术界委员会的研讨结果“关于草拟酮类类阿司匹林最主要环中氧化底物－2诱发剂和布洛芬的运用于拟议研讨会的一致意见”出版在美国消化道联合国开发计划署时会出版的9月份的《外科消化道联合国开发计划署时与肝脏联合国开发计划署时》杂志上。“酮类类阿司匹林是世界各地运用于最最常的药物，而且最常的运用于属实了它的效用和相对安全和性” 据阿拉巴马的大学时考文垂分校内医学时教授，论文的主要作者C. Mel Wilcox麻省理工学院介绍。“但是，从前虽然充分认识了肾脏胃癌，而没有注意到其脑部脆弱，美国消化道联合国开发计划署时会召集参众两院来减小对运用于该镇静剂的更进一步和肾脏及肠胃毒性的后果，从而改进对该镇静剂的运用于。”据估计世界各地每年消耗500亿布洛芬片，其中美国大约6000万份药剂开据了布洛芬，并主要给老年患者。这镇静剂对急、心理因素和骨骼肌肉炎症等层面必需。但是，酮类类阿司匹林的用作在在着更为严重的脆弱，最主要肾脏、肾脏和肠胃胃癌，甚至最主要高血压和冠心病。“我们高兴地看到酮类类阿司匹林的肾脏胃癌和死亡不太可能从1992年开始急剧下降，我们普遍认为这种状况众所周知一下层面：小血糖用作酮类类阿司匹林；降较高了肠道螺杆菌的流行；减小了质子泵诱发剂的运用于；以及引进对肾脏更安全和的酮类类阿司匹林的运用于，如昔布镇静剂。” Wilcox麻省理工学院说。“但是，医疗其他部门和患者必须明了该镇静剂的相关后果来草拟酮类类阿司匹林的最佳运用于拟议。学术界委员会为医疗其他部门草拟了当他们在最终是否给患者开酮类类阿司匹林时的表列建议：口碑疗程的化学时疗法和患者时有发生肾脏和肠胃胃癌的潜在脆弱生物体，并和患者研讨肠胃疾病的潜在脆弱生物体。对后果和更进一步进行分析方法来举例来说个体肾脏和肠胃脆弱后，开据较高后果的药物。肾脏囊肿时有发生脆弱大的病变必须运用于肾脏后果较高的酮类类阿司匹林，例如非抑制酮类类阿司匹林；肠胃政治事件时有发生后果大的病变必须接受环中氧底物－2诱发剂疗程；有已知肠胃疾病或病理学时后果的患者必须接受小血糖布洛芬。限制所开酮类类阿司匹林的持续时间和血糖，以及征询并建议患者进行酮类类阿司匹林的联合疗程。在运用于酮类类阿司匹林疗程前所，先行处理肠道螺杆菌的感染，以致不减小并发消化性溃疡的后果。针对肾脏胃癌后果大的病变草拟消化道人身安全拟议，如运用于米索前所列醛或质子泵诱发剂。“酮类类阿司匹林的运用于在在较高肾脏胃癌在诊断和疗程上很重要，” Wilcox麻省理工学院暗示说。“好处地理解较高肾脏囊肿时有发生的后果和成因是减少酮类类阿司匹林的用作脆弱所必须的。”在参众两院期间研讨的药剂都是非类诱发炎症底物的药物，因此在学时术上被普遍认为是酮类类阿司匹林。非抑制的酮类类阿司匹林，最主要布洛芬、借助于度酸和萘丁美酮，它们比其他酮类类阿司匹林，例如舒林酸、酮类美辛、吡罗昔康和酮咯酸对肾脏不具更高的安全和性。昔布镇静剂是抑制环中氧化底物－2抑制。在标准血糖下，扑热息痛不是酮类类阿司匹林。美国消化道联合国开发计划署时会学术界委员会由消化道联合国开发计划署时、风湿联合国开发计划署时、脑部联合国开发计划署时和内医学时护士组成，他们在小组研讨后，以当前所科研简报为基础草拟了这个拟议。美国消化道联合国开发计划署时会筹办的“关于酮类类阿司匹林的运用于的参众两院”由TAP药品公司提供的一项无限教育基金资助。参与者的税制开销公布包含在抄录内，在www.cghjournal.org. Nonsteroidal anti-inflammatory drugs use associated with higher gastrointestinal complications Consensus panel develops recommendations to minimize risks Nonsteroidal anti-inflammatory drugs (NSAIDs) provide a broad range of benefits for patients who require their use, but health care providers need to carefully consider the associated risks before prescribing these drugs for their patients, according to a multi-disciplinary panel of experts convened by the AGA Institute. Gastrointestinal (GI) morbidities are the most common adverse events associated with NSAID use, including complications in both the upper- and lower-GI tracts; serious GI complications, such as potentially fatal bleeding ulcers, occur in one to four percent of NSAID users annually. The findings of the panel, "Consensus Development Conference on the Use of Nonsteroidal Anti-Inflammatory Agents, Including Cyclooxygenase-2 Enzyme Inhibitors and Aspirin," were published in the September issue of Clinical Gastroenterology and Hepatology, published by the American Gastroenterological Association (AGA) Institute. "NSAIDs are the most widely used medications in the world, and the broad use of these drugs confirms their effectiveness and relative safety," according to C. Mel Wilcox, MD, professor of medicine, University of Alabama at Birmingham, and lead author of the paper. "However, well-recognized GI complications and previously unrecognized cardiac risks he caused great concern about the use of these drugs among healthcare professionals. The AGA Institute convened the consensus conference to increase awareness about the benefits and the risks of GI and cardiovascular toxicities associated with these medications and to improve their use." An estimated 50 billion aspirin tablets are consumed worldwide and approximately 60 million prescriptions are written for NSAIDs each year in the U.S., predominantly for older patients. These drugs are effective in acute and chronic treatment of painful and inflammatory musculoskeletal conditions, among others. However, NSAID use is associated with several risks including GI, renal and cardiovascular complications, including heart failure and myocardial infarction. "We were pleased to note that both NSAID-associated GI complications and death he been decreasing since 1992, which we believe can be attributed to several factors: use of lower-dose NSAIDs; decreasing prevalence of H. pylori; increasing use of proton-pump inhibitors; and the introduction of NSAIDs with greater GI safety, such as coxibs," said Dr. Wilcox. "However, healthcare providers and patients need to be aware of the risks associated with these drugs to develop the best plan for using NSAID therapy." The panel developed the following recommendations for healthcare providers to use when determining whether to prescribe NSAID treatment to their patients: ◎Review the treatment indication and potential patient risk factors, both for GI and cardiovascular complications, and discuss potential cardiovascular risk factor modifications with their patients. ◎Prescribe lower-risk agents after conducting a risk-benefit ysis to determine the GI versus cardiovascular risks for each individual. Patients who are at greater risk of GI bleeding should receive NSAIDs with lower GI risks, such as nsNSAIDs; patients with a greater risk of cardiovascular events should not receive COX-2 inhibitors; and patients with known or a high risk of cardiovascular disease should receive low-dose aspirin. ◎Limit the duration and dosage of the prescribed NSAID and ask about and advise their patients on combination NSAID therapy. ◎Treat patients with H. pylori infection prior to beginning NSAID therapy so as not to increase the risk of complicated ulcers. ◎Institute gastroprotection methods, such as misoprostol or proton pump inhibitors (PPIs), for patients at high-risk of GI complications. "The association of NSAID use with lower-GI tract complications is important diagnostically and therapeutically," explained Dr. Wilcox. "A better understanding of risk factors for and mechanisms of lower-GI tract bleeding in NSAID users will be required to address risk reduction." All agents discussed during the consensus conference were nonsteroidal, inhibit inflammation, and thus are technically considered NSAIDs. Nonselective NSAIDs include ibuprofen, etodolac and nabumetone, which may he superior GI safety than other nsNSAIDs, such as sulindac, indomethacin, piroxicam and ketorolac. Coxibs are selective NSAIDs. In standard doses, acetaminophen is not an NSAID. The AGA Institute panel was comprised of physicians in gastroenterology, rheumatology, cardiology and internal medicine who developed the statement based on presentations of current scientific knowledge followed by group discussion. The AGA Institute "Consensus Development Conference on the Use of Nonsteroidal Anti-Inflammatory Agents" was supported though an unrestricted educational grant from TAP Pharmaceutical Products Inc. Financial disclosures for conference participants are included in the manuscript at www.cghjournal.org.编辑：bluelove 编辑： Zhu