课件：NSAIDs相关性溃疡的防治现状.ppt

* 答辩主席、各位辩委，各位老师、同学，谢谢参加我的论文答辩会，我向大家汇报的题目是：利用RNAi技术对胰腺癌细胞BxPC-3凋亡抑制蛋白XIAP抑制的研究 * * * * * * * 答辩主席、各位辩委，各位老师、同学，谢谢参加我的论文答辩会，我向大家汇报的题目是：利用RNAi技术对胰腺癌细胞BxPC-3凋亡抑制蛋白XIAP抑制的研究 Aspirin剂量与溃疡出血危险度 Aspirin Dose 75 mg (n=27) 150 mg (n=22) 300 mg (n=62) Odds Ratio (95% Cl) 2.3 (1.2-4.4) 3.2 (1.7-6.5) 3.9 (2.5-6.3) Weil J et al. BMJ. 1995;310:827-830. National cohort study in Denmark 27,694 people on aspirin 100-150 mg qd Treatment regimen Increased incidence over general population 95% CI Low-dose aspirin Low-dose aspirin + NSAIDs 2.6 5.6 2.2 - 2.9 4.4 - 7.0 Sorensen et al, Am J Gastroenterol 2000; 95; 2218 Risk of Combining Low-Dose Aspirin with NSAIDs 根除Hp可降低NSAIDs溃疡危险度 Naproxen 750 mg/d for 8 wks Diclofenac SR 1000 mg/d for 26 wks Chan et al. Lancet 2002 Ulcer at 8 wk % Ehsanullah et al. BMJ 1988 P=0.024 NSAID + Ranitidine 150 mg b.i.d. N=263 NSAID + Placebo 常规剂量H2RA不能预防NSAIDs性胃溃疡 THANK YOU SUCCESS * * 可编辑 Taha et al. NEJM 1996 N=285 OGD Week 0 24 4 8 NSAID + Placebo NSAID + Famotidine 40 mg/d NSAID + Famotidine 80 mg/d 0 5 10 15 20 25 Famotidine 80 Famotidine 40 Placebo GU DU 24-wk ulcer % P=0.03 大剂量Famotidine预防NSAIDs相关性溃疡 MUCOSA Study NSAID + Misoprostol 800 ?g/d N=8843 Week 0 24 NSAID + placebo Endpoint serious GI complications Relative risk reduction 40% p-value 0.049 Silverstein et al. Ann Intern Med 95 *Dropout rate 27.5% due to GI side effects Number needed to treat (NNT) = 264 COX抑制剂：CLASS studyEndpoint: ulcer complications Silverstein et al. JAMA 2000 11/ 1441? 20/ 1384? 1.45% 0.76% P=0.09 ?event per patient-year of exposure Arthritis (RA) Rofecoxib 50 mg QD Naproxen 500 mg BID N = 8076 Month 0 1 2 3 4 5 6 7 8 9 10 11 12 VIGOR studyEndpoint: Clinical upper GI events Coxib vs. NSAIDs+PPI for high-risk patients Celecoxib 200 mg bid + omeprazole placebo od Diclofenac 75 mg bid + omeprazole 20 mg od Inclusion NSAID-related ulcer bleed; and Healed ulcer before randomization; and HP-