本文選題：非甾類抗炎藥　切入點(diǎn)：小腸滲透性　出處：《安徽醫(yī)科大學(xué)》2014年碩士論文　論文類型：學(xué)位論文

【摘要】：目的1.收集安徽省立醫(yī)院近三年消化道出血病例,分析引起消化道出血的病因、誘因及其與服用NSAIDs相關(guān)性。2.探討NSAIDs對骨關(guān)節(jié)炎(OA)及類風(fēng)濕關(guān)節(jié)炎(RA)患者小腸滲透性的影響,及替普瑞酮對NSAIDs所致小腸損傷的防治作用。方法1.回顧性分析安徽省立醫(yī)院2010年4月至2012年10月間消化道出血病例1001例,分析消化道出血的病因、誘因。2.收集服用NSAIDs的類風(fēng)濕關(guān)節(jié)炎患者(RA)30例、骨關(guān)節(jié)炎患者(OA)16例,健康對照組10例,通過高效液相色譜法測定患者在服用乳果糖及甘露醇后6小時(shí)內(nèi)排出尿液中乳果糖和甘露醇排泄率比值(L/M),然后分別比較未使用NSAIDs,使用NSAIDs后,及加用替普瑞酮后,L/M排泄率比值是否具有統(tǒng)計(jì)學(xué)意義,并對不同類型NSAIDs及不同疾病之間L/M排泄率比值進(jìn)行比較。結(jié)果1.結(jié)果顯示,消化道出血原因依次為消化性潰瘍、肝硬化胃底食管靜脈破裂、消化道腫瘤、小腸相關(guān)疾病及急性胃食管粘膜病變等。誘因則有誘因未明、飲食不當(dāng)患者、服用NSAIDs或加糖皮質(zhì)激素、酗酒、勞累精神緊張等。2.①10例健康對照的L/M排泄率比值為0.0240±0.0064,未使用NSIADs的17例患者L/M排泄率比值為0.0508±0.0254,較健康對照升高,但差異無統(tǒng)計(jì)學(xué)意義。使用NSAIDs的34患者L/M排泄率比值為0.1431±0.1691,較未使用NSAIDs者顯著升高(P0.01)。10例使用替普瑞酮的患者L/M排泄率比值為0.0442±0.0146,較單純使用NSAIDs患者顯著降低(P0.01)。②服用不同NSAIDs患者L/M排泄率比值分別為雙氯芬酸(n=17,0.1361±0.1972),氯諾昔康(n=8,0.2511±0.3111),奧沙普嗪(n=7,0.0812±0.0584),三組間差異無統(tǒng)計(jì)學(xué)意義(F=1.263,P=0.2995)。③類風(fēng)濕關(guān)節(jié)炎L/M排泄率比值(n=30,0.2112±0.2963)顯著高于骨關(guān)節(jié)炎(n=16,0.0634±0.0472)和健康對照,差異有統(tǒng)計(jì)學(xué)意義(P=0.0147)。結(jié)論1.消化道出血最常見原因是消化道潰瘍,消化道出血最常見誘因并非NSAIDs,高齡服用NSAIDs與消化道出血密切相關(guān)。2.NSAIDs增加關(guān)節(jié)炎患者小腸粘膜通透性;NSAIDs對小腸粘膜通透性改變與COX 2選擇性無關(guān);類風(fēng)濕關(guān)節(jié)炎患者腸粘膜通透性顯著增加;替普瑞酮能保護(hù)NSAIDs引起的腸粘膜通透性改變。
[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 鹵0.0064 in 2.110 healthy controls and 0.0508 鹵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 鹵0.1691, which was significantly higher than that in patients without NSAIDs. The ratio of L / M excretion rate was 0.0442 鹵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 鹵0.1972n, 0.2511 鹵0.3111g, 0.0812 鹵0.0584m, respectively. There was no significant difference among the three groups. The LM excretion rate of rheumatoid arthritis was 0.2112 鹵0.2963), which was significantly higher than that of osteoarthritis (n 160.0634 鹵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.
【學(xué)位授予單位】：安徽醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R57

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本文編號(hào)：1592902