非甾体抗炎药的研究进展

本文综述了近年来非甾体类抗炎药的基础研究、新的临床用途和研究前景。     

非甾体抗炎药的新进展

<正> 近年来,越来越多的抗炎镇痛新药已经用于风湿病的治疗,这些药物临床作用的基础在于抑制前列腺素的合成,然而它们在不同的疾病中有不同的作用。由于它们精细的作用方式不尽相同,其药理作用和毒性也差异很大,特别是不同病人对不同的非甾体抗炎药(NSAID)有完全不同的反应。因此,试制多种药物以适应治疗的个体化,对各种病人寻求最有效的治疗方案是很有价值的,同时必须记住这些药物     

非甾体抗炎药与阿尔茨海默病

阿尔茨海默病(Alzheimer disease,AD)是一种慢性进行性中枢神经系统变性疾病,占整个痴呆病人的75%,病因未明,药物治疗非常有限。最近的研究强调炎症和免疫机制在变性过程中的重要性。非甾体抗炎药(NSAID)是一组具有解热镇痛、消炎、抗风湿、抗血小板聚集的药物,种类很多,常用的药物近20种。按环氧合酶(COX)的新分类法可分为:①COX 非特异性抑制药:如吲哚美辛、布洛芬、萘普生;②COX-1特异性抑制药:如小剂量阿司匹林(ASA);③COX-2选择性(倾向性)抑制药:萘丁美酮、美洛昔康;④COX-2特异性抑制药:塞来昔布、罗非昔     

非甾体抗炎药的研发近况

2005年4月7日美国FDA发表了非甾体类抗炎药有增加心血管不良事件和胃肠道出血的潜在风险的声明;我国国家食品药品监督管理局随之也表示,将对这类药品的安全性问题予以“密切关注”。     

非甾体抗炎药与结肠直肠癌

流行病学和临床研究均发现,非甾体抗炎药能够降低结肠直肠癌发病率。这一重大发现无疑对预防结肠直肠癌,降低其发病率,提高人类健康水平具有十分重要的意义。     

非甾体抗炎药的临床研究新进展

非甾体抗炎药(NSAIDs)是临床上广泛应用的一类具有解热镇痛,大部分还有抗炎、抗风湿作用的药物.非甾体抗炎药的不良反应如消化道损害,肝肾损害发生率较高,针对这些不良发应开发了许多新的药物,如非甾体缓(控)释剂、非甾体和胃肠道保护剂的复方制剂、NO型非甾体药物等.近期研究还发现,非甾体抗炎药除了传统的治疗作用外,对阿尔茨海默病、早产、癌症等疾病均有预防或治疗作用,其临床应用不断扩展.本文就非甾体抗炎药的临床研究新进展作一综述.     

非甾体抗炎药物的临床药理进展

<正> 从19世纪末水杨酸类使用于临床开始,非甾体抗炎药(NSAIDs)的研究已有近百年的历史,但对于该类药物的现代临床药理学的研究仅仅是近20年内的事情。随着研究的不断深入,有关NSAIDs的临床及亚细胞生化作用正在不断地被揭示,并有力地推动着新型NSAIDs的发展。     

Spontaneous reporting of adverse drug reactions to non-steroidal anti-inflammatory drugs

Non-steroidal anti-inflammatory drugs (NSAIDs) are the third most commonly prescribed group of drugs in Spain. We present here the profile of adverse drug reactions (ADRs) attributed to them and reported to the Spanish System of Pharmacovigilance (SSPV) between 1983 and 1991, together with a preliminary analysis of topical, slow-release (SR) and enteric-coated (EC) preparations.Out of 18 348 reports of ADRs included in the SSPV database, 1609 (8.8%) implicated an NSAID. NSAIDs ranked second after antibiotics (15.1% of all reports) among the most commonly implicated drugs. Half of the patients were more than 55 years old, and 60% were women.Diclofenac (364 reports), piroxicam (282), indomethacin (197), naproxen (155), and ketoprofen (137) were the most commonly implicated NSAIDs in reports of ADRs.The most commonly reported ADRs were gastrointestinal (39%), cutaneous (20%), and those affecting the central and peripheral nervous system (9%). Seven reactions had a fatal outcome, and 138 were considered life threatening. Forty-nine reports included previously undescribed ADRs.There were 98 reports describing ADRs attributed to topical NSAIDs; 5 of these described 11 general reactions, such as duodenal ulcer, gastrointestinal bleeding, diarrhoea, dyspnoea, facial oedema, aggravation of bronchospasm, and angioedema.One hundred and sixty-eight reports referred to SR and EC preparations. The ratio of gastrointestinal to non-gastrointestinal reactions to SR-EC diclofenac was higher in the case of SR-EC diclofenac than in the case of plain diclofenac (P=0.037); similarly, the ratio of CNS to non-CNS reactions to SR-EC indomethacin was also higher than the corresponding ratio with plain indomethacin (P=0.002). Although differential selective reporting of these preparations cannot be excluded, these results raise doubts about the relative safety of SR and EC preparations of NSAIDs in practice.     

上海地区非甾体抗炎药不良反应回顾与分析

目的 调查上海市长期使用非甾体抗炎药(NSAIDs)人群药物不良反应发生情况及相关参数。方法 用整群抽样,回顾性询问填表法,获取了1002例患者的基本情况、NSAID s使用情况、合并用药情况和药物不良反应(发生、治疗、预后)等情况。结果 调查显示,患者使用NSAIDs均在1年以上,药物不良反应发生率较高(66％),症状主要集中在胃肠道、皮疹、中枢症状,严重药物不良反应约7％,药物不良反应预后较好。结论 NSAID s药物不良反应受多种因素影响。     

结肠直肠癌和非甾类消炎药(英文)

Non-steroidal anti-inflammatory drugs ( NSAIDs) can prevent or reduce the occurrence of colorectal cancers . Anti-carcinogenic properties of NSAIDs have been demonstrated in epidemiological studies of humans and experimental animals. In addition, clinical studies of familial adenomatous polyposis and sporadic adenomas have demonstrated that NSAIDs induce regression of colorectal adenomas and prevent formation of these tumors. NSAIDs thus induce early disruption of the adenoma-carcinoma sequence and may mainly suppress subsequent cancer formation at adenoma stage. The mechanism of the anti-carcinogenic effect of these drugs is not known, but results of most studies support that cyclooxygenase-2 (an inducible isoform of prostaglandin synthetase, COX-2) is a major target of NSAIDs in this effect. Recent immunohistochemical studies have revealed that COX-2 is expressed not in tumor cells but in interstitial cells of colonic adenomas. Accordingly, NSAIDs may exhibit anti-carcinogenic property through the inh     

Upper gastrointestinal disorders induced by non-steroidal anti-inflammatory drugs

Aims: We examined the characteristics of upper gastrointestinal disorders induced by non-steroidal anti-inflammatory drugs (NSAIDs). Methodology: The questionnaire investigation was performed over a five year period. Results: A study was performed on 354 patients (161 men and 193 women with mean ages of 66.0 and 70.7 years, respectively) who developed NSAIDs associated upper GI disorders: 21 patients had AGML, 212 had gastric ulcer, 63 had duodenal ulcer, 17 had gastroduodenal ulcers and 41 other cases. About 75 % of patients received NSAIDs for orthopedic conditions. Sixty percent of gastric disorders induced by NSAIDs affected the antrum or angulus of the stomach. The incidence of disorders of the gastric antrum was significantly higher in women than in men whilst the incidence of disorders on the gastric angulus was significantly higher in men than in women (p < 0.05). The proportion of patients with abdominal pain was significantly lower in patients over 65 years old than in those under 65 years old, and the proportion of patients with hematemesis or melena was significantly higher in patients over 80 years old than in those under 80 years old (p < 0.05). The time taken to achieve the healing stage was significantly longer in patients with greater than 3 months NSAIDs ingestion compared to patients that had received NSAIDs for less than 3 months (p < 0.05). Conclusions: Patients 65 years old and over with continuous NSAIDs use had asymptomatic ulcers, and patients 80 years old and over had hemorrhagic ulcers. Received and accepted 20 September 2006     

非甾体抗炎药物在骨性关节炎中的应用

骨性关节炎是老年人中常见、多发的慢性进行性骨关节疾病,主要临床表现为缓慢发展的可使活动受限的关节疼痛、僵硬和肿胀,严重的能导致关节功能障碍.非甾体抗炎药物是目前治疗骨性关节炎等关节炎性疾病的最常用药物,作用机制为抑制环氧化酶活性、阻断该酶催化花生四烯酸转化为炎性物质前列腺素,从而发挥止痛、消炎作用.非甾体抗炎药物分为非选择性环氧化酶抑制剂和选择性环氧化酶-2抑制剂两类,应用广泛,但也存在多种不良反应,故选择用药时要严格掌握适应证,合理用药.     

非甾体抗炎药物在骨性关节炎中的应用

骨性关节炎是老年人中常见、多发的慢性进行性骨关节疾病,主要临床表现为缓慢发展的可使活动受限的关节疼痛、僵硬和肿胀,严重的能导致关节功能障碍。非甾体抗炎药物是目前治疗骨性关节炎等关节炎性疾病的最常用药物,作用机制为抑制环氧化酶活性、阻断该酶催化花生四烯酸转化为炎性物质前列腺素,从而发挥止痛、消炎作用。非甾体抗炎药物分为非选择性环氧化酶抑制剂和选择性环氧化酶-2抑制剂两类,应用广泛,但也存在多种不良反应,故选择用药时要严格掌握适应证,合理用药。     

甲氨蝶呤联合柳氮磺吡啶与非甾体类抗炎药治疗类风湿性关节炎的效果对比

目的：对比甲氨蝶呤联合柳氮磺吡啶与非甾体类抗炎药治疗类风湿性关节炎的疗效。方法：选择2011年4月～2013年9月在我院就诊的类风湿性关节炎患者共50例,采用随机方式将其分为观察组和对照组,观察组给予甲氨蝶呤联合柳氮磺吡啶进行治疗,对照组则使用非甾体类抗炎药。治疗1年后,记录两组疗效以及不良反应情况。结果：观察组治疗的总有效率明显高于对照组,差异具有统计学意义（u=3.8314,P=0.0001）,且观察组患者的各项指标明显优于治疗前,相比差异有统计学意义（P<0.05）。观察组不良反应总发生率明显低于对照组,差异有统计学意义（P<0.05）。结论：与非甾体类抗炎药相比,使用甲氨蝶呤联合柳氮磺吡啶治疗类风湿性关节炎的疗效更为显著。     

非甾体类抗炎镇痛药的研究进展与应用评价

非甾体类抗炎镇痛药物是一类临床常用药物,本文介绍了它们的研究进展,并对应用前景进行了展望。     

幽门螺杆菌感染与非甾体类抗炎药相关性初探

目的 探讨幽门螺杆菌感染与非甾体类抗炎药的关系。方法 将本院2004年1月至2005年12月期间收治的88例连续服用非甾体类抗炎药治疗4～12周的患者行胃镜及病理组织学检查，经检查将88例患者分为幽门螺杆菌感染组和非感染组，分析非甾体类抗炎药与幽门螺杆菌感染的关系。结果 幽门螺杆菌感染组36例，非甾体类抗炎药相关性胃病发生率16．67％（6／36），非幽门螺杆菌感染组52例，非甾体类抗炎药相关性胃病发生率19．23％（10／52）。结论 幽门螺杆菌感染并不加剧非甾体类抗炎药相关性胃病的发生。     

非甾体抗炎药致胃肠道黏膜损伤的研究进展

随着非甾体抗炎药(NSAIDs)在临床的广泛应用,其对胃肠道黏膜的损害已受到越来越多的关注。笔者就NSAIDs胃肠道黏膜损害的发病机制、临床表现和防治等做一综述。