美国胃肠病协会（AGA）有关开据 NSAIDs处方的建议

继发类较高mg的应用领域伴随高发循环系统道肝硬化专家组合意颁布提拔解决方案来减小危险性据加拿大循环系统病该学会齐集的协调发展专家组介绍，继发类较高mg给有适应症的患儿提供了开阔的有益于，但是卫生部门在给病者再上据这布洛芬从前，需要认真考虑它的伴随危险性。循环系统道病变是适用非类较高mg的最类似于的不良反应，除此以外上消化道和下消化道的肝硬化。严重的循环系统道肝硬化，如潜在的致命性出血性溃疡，年时有存活率为适用者的1－4％。专家组的争辩结果“关于颁布继发类较高mg除此以外马蹄形还原酶－2以致于剂和布洛芬的应用领域解决方案争辩会的共识”刊载在加拿大循环系统病该学会出版的9月份的《临床循环系统病学与肾脏病学》杂志上。“继发类较高mg是世界应用领域最广泛的药物，而且广泛的应用领域证实了它的功效和相较安全性性” 据查尔斯顿大学伯明翰分校内科学研究讲师，论文的主要作者C. Mel Wilcox博士介绍。“但是，过去虽然充分认识了循环系统道肝硬化，而没有认识到其心脏脆弱，加拿大循环系统病该学会齐集一致同意来增加对应用领域该布洛芬的有益于和循环系统道及心血管疾病毒性的危险性，从而简化对该布洛芬的应用领域。”少于世界每年损耗500亿布洛芬片，其中加拿大大约6000万份处方再上据了布洛芬，并主要给老年病者。这布洛芬对急、慢性疼痛和骨盆肌肉水肿等方面有效率。但是，继发类较高mg的适用伴随着严重的脆弱，除此以外循环系统道、肾脏和心血管疾病肝硬化，甚至除此以外心力衰竭和心肌梗死。“我们高兴地认出继发类较高mg的循环系统道肝硬化和死亡不太可能从1992年再上始急剧下降，我们显然这种状况归功于一下方面：小mg适用继发类较高mg；降较高了脊髓灰质炎索科利夫卡的大行其道；增加了质子泵以致于剂的应用领域；以及引进对循环系统道越来越安全性的继发类较高mg的应用领域，如昔布布洛芬。” Wilcox博士问道。“但是，卫生部门和病者需要了解该布洛芬的相关危险性来颁布继发类较高mg的最佳应用领域解决方案。专家组为卫生部门颁布了当他们在决定是否给病者再上继发类较高mg时的以下建议：评价疗程的适应症和病者时有发生循环系统道和心血管疾病肝硬化的潜在脆弱表征，并和病者争辩糖尿病的潜在脆弱表征。对危险性和有益于顺利进行系统性来加权个体循环系统道和心血管疾病脆弱后，再上据较高危险性的药物。循环系统道出血时有发生脆弱大的患儿需要应用领域循环系统道危险性较高的继发类较高mg，例如非胺类继发类较高mg；心血管疾病事件时有发生危险性大的患儿需要接受马蹄形氧酶－2以致于剂疗程；有已知糖尿病或心血管疾病病危险性的病者需要接受小mg布洛芬。管制所再上继发类较高mg的持续时间和mg，以及征询并建议病者顺利进行继发类较高mg的联合疗程。在应用领域继发类较高mg疗程从前，再解决问题脊髓灰质炎索科利夫卡的病菌，以致不增加即刻消化性溃疡的危险性。针对循环系统道肝硬化危险性大的患儿颁布循环系统保障解决方案，如应用领域米索从前列酯或质子泵以致于剂。“继发类较高mg的应用领域伴随较高循环系统道肝硬化在诊断和疗程上很重要，” Wilcox博士解释问道。“越来越快地理解较高循环系统道出血时有发生的危险性和机理是减少继发类较高mg的适用脆弱所需要的。”在一致同意长期争辩的药剂都亦非类以致于水肿反应的药物，因此在学术上被显然是继发类较高mg。非胺类的继发类较高mg，除此以外布洛芬、依托度酸和氯丁美酮，它们比其他继发类较高mg，例如舒林酸、吲哚美辛、吡罗昔康和酮咯酸对循环系统道具有越来越高的安全性性。昔布布洛芬是胺类马蹄形还原酶－2抑制剂。在标准mg下，扑热息痛不是继发类较高mg。加拿大循环系统病该学会专家组由循环系统病学、风湿病学、心脏病学和内科学研究医师合组，他们在小组争辩后，以当从前科研年度报告进一步将颁布了这个解决方案。加拿大循环系统病该学会举办的“关于继发类较高mg的应用领域的一致同意”由TAP药物公司提供的一项无限基础教育信托基金资助。与会者的税务再上销公布包含在原稿内，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