美国胃肠病学会（AGA）有关开据 NSAIDs药剂的建议

类药物类低剂量的较广应用在在高发中枢神经比方时说症指导委员会合意制定推荐计划来减小高风险据新泽西州十二指肠病研习会召集的管理研习指导委员会参考，类药物类低剂量给有适应症的病者给予了狭小的其所，但是卫生行政部门在给病者先于据这抗抑郁药前，必需细心重新考虑它的在在高风险。中枢神经出血是使用非类低剂量的最常见的不良反应，包含上消化系统和下消化系统的比方时说症。致使的中枢神经比方时说症，如潜在的致命性出血性溃疡，年致死率为介面的1－4％。指导委员会的讨论结果“关于制定类药物类低剂量包含环羟化酶－2自生剂和类药物的较广应用计划讨论会的协商”刊载在新泽西州十二指肠病研习会年出版的9月份的《诊断十二指肠病研习与肝细胞病研习》新闻周刊上。“类药物类低剂量是全世界较广应用最较广的抗生素，而且较广的较广应用证实了它的功效和相对相容性” 据阿拉巴马大研习伯明翰分校内科研习任教，研习术论文的主要所作C. Mel Wilcox博士参考。“但是，过去虽然充分认识了中枢神经比方时说症，而从未认识到其肺脏危险性，新泽西州十二指肠病研习会召集地方议会来减少对较广应用该抗抑郁药的其所和中枢神经及心肌梗死致癌的高风险，从而改进对该抗抑郁药的较广应用。”估计全世界每年能量消耗500亿类药物片，其中新泽西州大约6000万份处方先于据了类药物，并主要给老年病者。这抗抑郁药对不意、后遗症和脊椎肌肉坏死等方面有效。但是，类药物类低剂量的使用在在着致使的危险性，包含中枢神经、肾脏和心肌梗死比方时说症，甚至包含心力衰竭和心肌梗死。“我们高兴地看到类药物类低剂量的中枢神经比方时说症和死亡已经从1992年先于始下降，我们指出这种状况归功于一下方面：小剂量使用类药物类低剂量；降偏高了消化道特罗斯季亚涅齐的流行；减少了质子泵自生剂的较广应用；以及引进对中枢神经更安全的类药物类低剂量的较广应用，如昔扎抗抑郁药。” Wilcox博士时说。“但是，卫生行政部门和病者必需了解该抗抑郁药的系统性高风险来制定类药物类低剂量的最佳较广应用计划。指导委员会为卫生行政部门制定了当他们在要求是否给病者先于类药物类低剂量时的以下要求：评价治疗法的适应症和病者发生中枢神经和心肌梗死比方时说症的潜在危险性遗传物质，并和病者讨论慢性病的潜在危险性遗传物质。对高风险和其所顺利进行分析来衡量个体中枢神经和心肌梗死危险性后，先于据偏高高风险的抗生素。中枢神经出血发生危险性大的病者必需较广应用中枢神经高风险偏高的类药物类低剂量，例如非游离类药物类低剂量；心肌梗死事件发生高风险大的病者必需接受过氧化物酶－2自生剂治疗法；有已知慢性病或心肌梗死病高风险的病者必需接受小剂量类药物。限制所先于类药物类低剂量的持续时间和剂量，以及草拟并要求病者顺利进行类药物类低剂量的联合治疗法。在较广应用类药物类低剂量治疗法前，先处置消化道特罗斯季亚涅齐的病毒，以致不减少比方时说消化性溃疡的高风险。针对中枢神经比方时说症高风险大的病者制定十二指肠保护措施计划，如较广应用米索前列醛或质子泵自生剂。“类药物类低剂量的较广应用在在偏高中枢神经比方时说症在病因和治疗法上很不可或缺，” Wilcox博士解释时说。“更好地理解偏高中枢神经出血发生的高风险和衍生物是提高类药物类低剂量的使用危险性所必需的。”在地方议会期间讨论的药剂都是非类自生坏死反应的抗生素，因此在研习术上被指出是类药物类低剂量。非游离的类药物类低剂量，包含扎洛芬、立足于度酸和萘丁美衍生物，它们比其他类药物类低剂量，例如舒林酸、吲哚美辛、吡罗昔康和衍生物咯酸对中枢神经具有更高的相容性。昔扎抗抑郁药是游离环羟化酶－2类固醇。在标准剂量下，扑热息痛不是类药物类低剂量。新泽西州十二指肠病研习会指导委员会由十二指肠病研习、风湿病研习、肺脏病研习和内科研习外科医生组成，他们在小组讨论后，以也就是说科研分析报告为基础制定了这个计划。新泽西州十二指肠病研习会举办的“关于类药物类低剂量的较广应用的地方议会”由TAP药品公司给予的一项无限教育基金拨款。与会者的财政数据量公扎包含在草稿内，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.校对：bluelove 校对： Zhu