非甾体抗炎药对肠粘膜通透性的影响

发布时间：2018-03-10 10:17

  本文选题：非甾类抗炎药　切入点：小肠渗透性　出处：《安徽医科大学》2014年硕士论文　论文类型：学位论文

【摘要】：目的1.收集安徽省立医院近三年消化道出血病例,分析引起消化道出血的病因、诱因及其与服用NSAIDs相关性。2.探讨NSAIDs对骨关节炎(OA)及类风湿关节炎(RA)患者小肠渗透性的影响,及替普瑞酮对NSAIDs所致小肠损伤的防治作用。方法1.回顾性分析安徽省立医院2010年4月至2012年10月间消化道出血病例1001例,分析消化道出血的病因、诱因。2.收集服用NSAIDs的类风湿关节炎患者(RA)30例、骨关节炎患者(OA)16例,健康对照组10例,通过高效液相色谱法测定患者在服用乳果糖及甘露醇后6小时内排出尿液中乳果糖和甘露醇排泄率比值(L/M),然后分别比较未使用NSAIDs,使用NSAIDs后,及加用替普瑞酮后,L/M排泄率比值是否具有统计学意义,并对不同类型NSAIDs及不同疾病之间L/M排泄率比值进行比较。结果1.结果显示,消化道出血原因依次为消化性溃疡、肝硬化胃底食管静脉破裂、消化道肿瘤、小肠相关疾病及急性胃食管粘膜病变等。诱因则有诱因未明、饮食不当患者、服用NSAIDs或加糖皮质激素、酗酒、劳累精神紧张等。2.①10例健康对照的L/M排泄率比值为0.0240±0.0064,未使用NSIADs的17例患者L/M排泄率比值为0.0508±0.0254,较健康对照升高,但差异无统计学意义。使用NSAIDs的34患者L/M排泄率比值为0.1431±0.1691,较未使用NSAIDs者显著升高(P0.01)。10例使用替普瑞酮的患者L/M排泄率比值为0.0442±0.0146,较单纯使用NSAIDs患者显著降低(P0.01)。②服用不同NSAIDs患者L/M排泄率比值分别为双氯芬酸(n=17,0.1361±0.1972),氯诺昔康(n=8,0.2511±0.3111),奥沙普嗪(n=7,0.0812±0.0584),三组间差异无统计学意义(F=1.263,P=0.2995)。③类风湿关节炎L/M排泄率比值(n=30,0.2112±0.2963)显著高于骨关节炎(n=16,0.0634±0.0472)和健康对照,差异有统计学意义(P=0.0147)。结论1.消化道出血最常见原因是消化道溃疡,消化道出血最常见诱因并非NSAIDs,高龄服用NSAIDs与消化道出血密切相关。2.NSAIDs增加关节炎患者小肠粘膜通透性;NSAIDs对小肠粘膜通透性改变与COX 2选择性无关;类风湿关节炎患者肠粘膜通透性显著增加;替普瑞酮能保护NSAIDs引起的肠粘膜通透性改变。
[Abstract]:Objective 1. To collect the cases of gastrointestinal hemorrhage in Anhui Provincial Hospital in recent three years, and analyze the etiology, inducement and its correlation with taking NSAIDs. 2. To explore the effect of NSAIDs on intestinal permeability in patients with osteoarthritis and rheumatoid arthritis (RA). Methods 1. Retrospective analysis of 1001 cases of gastrointestinal hemorrhage from April 2010 to October 2012 in Anhui Provincial Hospital, the etiology of gastrointestinal hemorrhage was analyzed. Inducement .2. 30 cases of rheumatoid arthritis, 16 cases of osteoarthritis, 10 cases of healthy control group were collected. The excretion ratio of lactofructose and mannitol in urine was measured by high performance liquid chromatography within 6 hours after taking lactulose and mannitol. And whether the ratio of L / M excretion rate was statistically significant after the administration of tipranone, and to compare the ratio of L / M excretion rate between different types of NSAIDs and different diseases. Results 1. The results showed that the cause of gastrointestinal bleeding was peptic ulcer in turn. Cirrhosis of the fundus esophageal vein rupture, digestive tract tumors, small bowel related diseases and acute gastroesophageal mucosal lesions, and so on. The inducement is not clear, improper diet patients, taking NSAIDs or glucocorticoid, alcoholism, The ratio of L / M excretion rate was 0.0240 卤0.0064 in 2.110 healthy controls and 0.0508 卤0.0254 in 17 patients without NSIADs, which was higher than that in healthy controls. But there was no significant difference. The ratio of L / M excretion rate in 34 patients with NSAIDs was 0.1431 卤0.1691, which was significantly higher than that in patients without NSAIDs. The ratio of L / M excretion rate was 0.0442 卤0.0146 in 10 patients with tipranone, which was significantly lower than that in patients with NSAIDs alone. The ratio of L / M excretion rate to NSAIDs was 0.1361 卤0.1972n, 0.2511 卤0.3111g, 0.0812 卤0.0584m, respectively. There was no significant difference among the three groups. The LM excretion rate of rheumatoid arthritis was 0.2112 卤0.2963), which was significantly higher than that of osteoarthritis (n 160.0634 卤0.0472) and healthy control. Conclusion 1. The most common cause of gastrointestinal bleeding is digestive tract ulcer. The most common inducement of gastrointestinal hemorrhage was not NSAIDs.The changes of intestinal mucosal permeability were not related to the increase of intestinal mucosal permeability in patients with arthritis. There was no correlation between the changes of intestinal mucosal permeability and the selectivity of COX / 2. In patients with rheumatoid arthritis, intestinal mucosal permeability was significantly increased, and tipranone could protect intestinal mucosal permeability induced by NSAIDs.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R57

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