论文部分内容阅读
目的 对应用选择性环氧酶2(COX 2)抑制剂和非选择性的非甾体类抗炎药(NSAIDs)的老年患者上消化道出血的比率进行比较。 设计 观察性队列研究。 设置 利用来自加拿大安大略2000年4月17日～2001年3月31日的官方数据,以确认基于人群的、初次使用NSAID的队列患者。 对象 年龄≥66岁,开始服用非选择性NSAIDs(n=5391)、双氯芬酸(diclofenac)加米索前列醇(misoprostol)(n=5087)、罗非昔布(rofecoxib)(n=14 583)或塞来昔布(celecoxib)(n=18 908),以及随机选择的没有服用NSAIDs的对照组(n=100 000)。 衡量结局的主要指标 每个药物组因上消化道出血入院的比值比(经过调整潜在的混杂因子)。 结果 与对照组相比,多变量模型表明,在服用非选择性NSAIDs(调整比值比为4.0,95％,可信区间为2.3～6.9,)、双氯芬酸加米索前列醇(3.0,1.7～5.6)以及罗非昔布(1.9,1.3～2.8)时,上消化道出血的短期危险性是增加的,而塞来昔布并没有增加(1.0,0.7～1.6)。与塞来昔布相比,非选择性的NSAIDs(4.4,2.3～8.5)、双氯芬酸加 米索前列醇(3.2,1.6—6.5)以及罗非昔布(1.9,1.2～2.8)的上消化道出血危险性显著增加。与罗非昔布相比,非选择性NSAIDs的上消化道出血危险性显著增加(1.9,1.0～3.5)。 结论 选择性COX 2抑制剂的近期上消化道出血的危险
Objective To compare the rates of upper gastrointestinal bleeding in elderly patients with selective cyclooxygenase 2 (COX 2) inhibitors and nonselective NSAIDs. Design observational cohort studies. Set-up Utilizing official data from April 17, 2000, Ontario, Canada to March 31, 2001, Ontario, Canada, to confirm population-based, cohort naive patients with NSAID. Subjects ≥66 years of age who started taking nonselective NSAIDs (n = 5391), diclofenac plus misoprostol (n = 5087), rofecoxib (n = 14 583) or Celecoxib (n = 18 908) and a randomly selected control group without NSAIDs (n = 100 000). MAIN INDICATOR OF OUTCOME The odds ratio (adjusted for potential confounders) for each drug group due to upper gastrointestinal bleeding admission. Results Compared with the control group, the multivariable model showed that taking diclofenac plus plus misoprostol (3.0, 1.7 to 5.6) was associated with nonselective NSAIDs (adjusted odds ratio, 4.0; 95% confidence interval, 2.3 to 6.9) ) And rofecoxib (1.9, 1.3-2.8) increased the short-term risk of upper gastrointestinal bleeding and did not increase celecoxib (1.0, 0.7-1.6). Non-selective NSAIDs (4.4, 2.3-8.5), diclofenac plus misoprostol (3.2, 1.6-6.5) and upper gastrointestinal tract of rofecoxib (1.9,1.2-2.8) compared with celecoxib The risk of bleeding increased significantly. Compared with rofecoxib, non-selective NSAIDs significantly increased the risk of upper gastrointestinal bleeding (1.9,1.0 ~ 3.5). Conclusions Selective COX 2 inhibitors are associated with the risk of recent upper gastrointestinal bleeding