非甾体抗炎药治疗可显著增加小肠损伤的风险
作者：Tachecí I
翻译：北医三院 孙琳（sunlin1984920@126.com）
审核：北医三院 姚中强
目的：本前瞻性研究的目的是通过非侵入性无线肠镜评价类风湿关节炎（RA）或骨关节炎（OA）患者非甾体抗炎药（NSAIDs）导致的肠损伤情况。方法：共纳入143例患者（74例RA、69例OA），使用NSAIDs大于1个月，42例正常对照。所有受试者进行胶囊内镜检查，实验室检查和填写调查问卷。小肠损伤的严重程度进行分级为：轻度（红点或零星糜烂），中度（糜烂10-20）或重度（>20糜烂或溃疡）。结果：胶囊内镜确定小肠病变的患者44.8％（轻度36.4％，中度3.5％，重度4.9％）。11.9％健康志愿者检出轻度非特异性病变。与OA（31.9％）相比，RA患者（56.8％，P<0.01）肠病的发病率显著升高。使用NSAIDs的RA和OA患者伴发肠病者红细胞数（p <0.01）、白细胞计数（P<0.05）、血红蛋白（P<0.05）、红细胞压积（P<0.05）、血清白蛋白（p<0.01）、红细胞沉降率（p<0.05）与无肠病者有显著差别。肠病与消化不良、性别或年龄无明显相关。结论：NSAIDs治疗可显著增加小肠损伤风险，且RA患者的风险更高。附全文：Abstract The goal of this prospective study was to assess non-steroidal anti-inflammatory drug (NSAID)-induced enteropathy in patients with rheumatoid arthritis (RA) or osteoarthritis (OA) by means of non-invasive wireless capsule enteroscopy. A total of 143 patients (74 with RA, 69 with OA) treated with NSAIDs (>1 month) and 42 healthy volunteers were included. All subjects underwent capsule endoscopy, laboratory tests and filled in questionnaires. The severity of small bowel injury was graded as: mild (red spots or sporadic erosions), moderate (10-20 erosions) or severe (>20 erosions or ulcers). Capsule endoscopy identified small bowel lesions in 44.8 % of patients (mild 36.4 %, moderate 3.5 % and severe in 4.9 %). Mild non-specific lesions were found in 11.9 % healthy volunteers. There was a significantly higher prevalence of enteropathy in RA (56.8 %) compared to OA (31.9 %, p < 0.01). A significant difference between NSAID users (RA and OA) with and without enteropathy was observed in erythrocytes (p < 0.01), the leucocyte count (p < 0.05), haemoglobin (p < 0.05), haematocrit (p < 0.05), serum albumin (p < 0.01) and erythrocyte sedimentation rate (p < 0.05). No relationship was found between enteropathy and dyspepsia, gender or age. NSAID therapy is associated with a significant risk of small bowel injury. The risk is significantly higher in RA patients suggesting a possible influence of the underlying disease.
引自：Tachecí I, Bradna P, Douda T, Ba?tecká D, Kopá?ová M, Rejchrt S,Lutonsk? M, Soukup T, Bure? J. Small intestinal injury in NSAID users suffering from rheumatoid arthritis or osteoarthritis. Rheumatol Int. 2016 Aug 22. [Epub ahead of print]
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