Cox-2抑制剂导致OA和RA上胃肠道不良反应事件并不明显低于NSAID联合PPI

摘要：目的 比较COX-2抑制剂与NSAID联合质子泵抑制剂（PPI0对预防骨关节炎和类风湿关节炎患者胃肠道不良反应事件（含上胃肠道不良反应事件和胃肠道症状）中的作用。

方法 检索了1990年到2010年12月发表在PubMed、 Cochrane图书馆、EMBASE、ISI知识网、中国生物文献数据库和有关论文参考文献目录中的论文，筛选出与该研究标准相配的资料，应用RevMan (5.0)软件进行统计学分析。

结果:总共有6项随机对照试验（6219例患者）的荟萃分析显示，COX-2抑制剂与非选择性NSAID联合PPI引起的上胃肠道副作用事件[相对风险度 0.61, 95%CI为 0.34-1.09]、胃肠道症状(RR 1.10, 95% CI: 0.88-1.39)及心血管副作用方面(RR 1.67, 95% CI: 0.78-3.59)均无明显差异。

结论: Cox-2抑制剂对骨关节炎和类风湿关节炎患者诱发的上胃肠道不良反应事件、胃肠道症状和心血管副作用事件并不优于NSAID联合PPI。基于目前的证据和患者希望，临床医生在选择NSAID加PPI还是COX-2抑制剂方面要仔细考虑和权衡胃肠道和心血管风险。

附原文：Abstract OBJECTIVE: To compare cyclooxygenase-2 (Cox-2) inhibitors alone with NSAIDs plus proton pump inhibitors (PPIs) in preventing gastrointestinal adverse events: upper gastrointestinal (UGI) adverse events and gastrointestinal symptoms in Osteoarthritis and Rheumatoid arthritis.METHODS: PubMed, the Cochrane Library, EMBASE, ISI Web of Knowledge, Chinese Biomedical Literature Database, and reference lists of relevant papers for articles published 1990-2010.12 were searched. The related data matching standards set for this study were extracted. Statistical analyses were carried out using RevMan (5.0) software.RESULTS: The meta-analysis of six randomized controlled trials with a total of 6219 patients revealed that there was no difference in the UGI adverse events between Cox-2 inhibitors and nonselective NSAIDs with concurrent use of PPIs [relative risk (RR) 0.61, 95% confidence interval (CI) 0.34-1.09]. There was no significant difference in gastrointestinal symptoms (RR 1.10, 95% CI: 0.88-1.39) and the cardiovascular adverse events (RR 1.67, 95% CI: 0.78-3.59) between the two groups. CONCLUSION: Cox-2 inhibitors are no better than nonselective NSAIDs with PPIs in regard to UGI adverse events, gastrointestinal symptoms and cardiovascular adverse events in Osteoarthritis and Rheumatoid arthritis. On the basis of the current evidence and the combined wishes of the patient, clinicians should carefully consider and weigh both gastrointestinal and cardiovascular risk before selecting NSAID plus PPIs or Cox-2 inhibitors.

引自：Wang X, Tian HJ, Yang HK, Wanyan P, Peng YJ.Meta-analysis: cyclooxygenase-2 inhibitors are no better than nonselective nonsteroidal anti-inflammatory drugs with proton pump inhibitors in regard to gastrointestinal adverse events in osteoarthritis and rheumatoid arthritis. Eur J Gastroenterol Hepatol. 2011 Oct;23(10):876-80.