美国胃肠病学会（AGA）有关开据 NSAIDs用药的建议

对乙酰氨基酚类不良反应的分析方法牵动高发消化道冠心病专家组亦非订定延揽拟议来减小高风险据美国政府胃肠心血管病术委员会商量的多学时科专家组参阅，对乙酰氨基酚类不良反应给有适应症的患者提供者了广阔的更进一步，但是保健业务部门在给病童开据这抑制剂前，须要仔细考虑它的牵动高风险。消化道病变是使用非类不良反应的最常见的不良反应，还包括上消化道和下消化道的冠心病。严重影响的消化道冠心病，如潜在的致命性坏死性息肉，年发生率为使用者的1－4％。专家组的争论结果“关于订定对乙酰氨基酚类不良反应还包括环中氧化蛋白－2诱导剂和对乙酰氨基酚的分析方法拟议交流会的诚意”出版在美国政府胃肠心血管病术委员会选集的9中旬的《外科胃肠心血管病与肝脏心血管病》Magazine上。“对乙酰氨基酚类不良反应是迄今为止分析方法最广泛的药物，而且广泛的分析方法证实了它的功用和相对安全性” 据阿拉巴马该大学时伯明翰两所内科学时博士，助手论文的主要作者C. Mel Wilcox助手参阅。“但是，过去虽然充分认识了消化道冠心病，而没坚信其心脏脆弱，美国政府胃肠心血管病术委员会商量立法机构来缩减对分析方法该抑制剂的更进一步和消化道及哮喘毒素的高风险，从而改良对该抑制剂的分析方法。”有约迄今为止每年耗费500亿对乙酰氨基酚片，其中美国政府据估计6000万份处方开据了对乙酰氨基酚，并主要给老年病童。这抑制剂对急、慢性疼痛和骨骼躯干坏死等各个方面适当。但是，对乙酰氨基酚类不良反应的使用牵动着严重影响的脆弱，还包括消化道、肾脏和哮喘冠心病，甚至还包括败血症和冠心病。“我们欣喜地看得见对乙酰氨基酚类不良反应的消化道冠心病和死亡已经从1992年开始下降，我们普遍认为这种状况归因于一下各个方面：小口服使用对乙酰氨基酚类不良反应；降高了小肠索科利夫卡的流行；缩减了质子泵诱导剂的分析方法；以及导入对消化道更安全的对乙酰氨基酚类不良反应的分析方法，如昔札抑制剂。” Wilcox助手感叹。“但是，保健业务部门和病童须要了解该抑制剂的具体高风险来订定对乙酰氨基酚类不良反应的最佳分析方法拟议。专家组为保健业务部门订定了当他们在重新考虑确实给病童开对乙酰氨基酚类不良反应时的以下提议：评价病童的适应症和病童发生消化道和哮喘冠心病的潜在脆弱特异性，并和病童争论哮喘疾病的潜在脆弱特异性。对高风险和更进一步进行分析来衡量群体消化道和哮喘脆弱后，开据高高风险的药物。消化道坏死发生脆弱大的患者须要分析方法消化道高风险高的对乙酰氨基酚类不良反应，例如非丝氨酸对乙酰氨基酚类不良反应；哮喘事件发生高风险大的患者须要做环中氧蛋白－2诱导剂病童；有已知哮喘疾病或哮喘病高风险的病童须要做小口服对乙酰氨基酚。限制所开对乙酰氨基酚类不良反应的持续时间和口服，以及征询并提议病童进行对乙酰氨基酚类不良反应的联合病童。在分析方法对乙酰氨基酚类不良反应病童前，先处理小肠索科利夫卡的感染，以致不缩减模版消化性息肉的高风险。针对消化道冠心病高风险大的患者订定胃肠保护拟议，如分析方法米索前列醇或质子泵诱导剂。“对乙酰氨基酚类不良反应的分析方法牵动高消化道冠心病在诊断和病童上很关键，” Wilcox助手解释感叹。“更好地理解高消化道坏死发生的高风险和机理是减少对乙酰氨基酚类不良反应的使用脆弱所须要的。”在立法机构期间争论的药剂都亦非类诱导坏死反应的药物，因此在社会科学时上被普遍认为是对乙酰氨基酚类不良反应。非丝氨酸的对乙酰氨基酚类不良反应，还包括不良反应、依托度酸和萘丁美酮，它们比其他对乙酰氨基酚类不良反应，例如舒林酸、吲哚美辛、吡罗昔康和酮咯酸对消化道具有更高的安全性。昔札抑制剂是丝氨酸环中氧化蛋白－2抑制剂。在标准口服下，扑热息痛不是对乙酰氨基酚类不良反应。美国政府胃肠心血管病术委员会专家组由胃肠心血管病、风湿心血管病、心脏心血管病和内科学时医师组成，他们在小组争论后，以当前人才培养报告为基础订定了这个拟议。美国政府胃肠心血管病术委员会筹办的“关于对乙酰氨基酚类不良反应的分析方法的立法机构”由TAP本品美国公司提供者的一项无限高等教育基金捐助。参与者的支出开销公札还包括在原稿内，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.出版人：bluelove 出版人： Zhu