2023 年第 8 期 第 18 卷

质子泵抑制剂预防应激性溃疡的有效性和安全性及经济性评价研究

Efficacy, safety and economic evaluation of proton pump inhibitors in the prevention of stress ulcer

作者：罗巧1鲁松1刘碧晴2王之舟1董宪喆1张兰1

英文作者：Luo Qiao1 Lu Song1 Liu Biqing2 Wang Zhizhou1 Dong Xianzhe1 Zhang Lan1

单位：1首都医科大学宣武医院药学部，北京100053；2首都儿科研究所附属儿童医院药学部，北京100020

英文单位：1Department of Pharmacy Xuanwu Hospital Capital Medical University Beijing 100053 China; 2Department of Pharmacy Children′s Hospital Capital Institute of Pediatrics Beijing 100020 China

关键词：应激性溃疡；质子泵抑制剂；快速卫生技术评估

英文关键词：Stressulcer;Protonpumpinhibitors;Rapidhealthtechnologyassessment

• 摘要：

• 目的 快速评价质子泵抑制剂（PPI）预防应激性溃疡（SU）在不同人群中使用的有效性、安全性和经济性，为临床合理应用提供循证依据。方法 检索中国知网、万方数据库、PubMed、Embase等中英文数据库以及卫生技术评估官方网站，查询PPI对比同类或其他抗酸药/安慰剂预防SU的系统评价/Meta分析以及经济性研究。使用系统评价方法学质量评价工具量表和卫生经济学评价报告标准共识量表评估文献的质量，对结果进行定性分析。结果 共纳入18篇系统评价/Meta分析、9篇经济性研究。纳入文献质量较好，评分均在8～9分。在有效性方面，对重症监护病房、围术期、SU、溃疡高风险及脑血管疾病的患者，使用PPI的效果优于H2受体阻滞剂和安慰剂；对慢性肾脏病与急性心肌梗死的患者预防效果优于安慰剂；在对患者的死亡率影响方面，与对照组相比，脑血管疾病患者中PPI降低死亡率更优，而在急性心肌梗死、SU和重症监护病房患者中PPI与其他药物降低死亡率的差异无统计学意义（P>0.05）。在安全性方面，PPI显著增加艰难梭菌感染风险，肺炎发生率与对照组差异无统计学意义（P>0.05）。在经济性方面，与H2受体阻滞剂相比，PPI预防SU的经济性较差。结论  PPI预防性使用可降低高危患者SU引发的出血，但安全性和经济性比其他抗酸药差。

• Objective To rapidly evaluate the efficacy, safety and economy of proton pump inhibitors(PPI) in preventing stress ulcers(SU) in different populations, so as to provide reference for rational clinical application. Methods  Retrieve Chinese and English databases such as China National Knowledge Infrastructure, Wanfang Database, PubMed, Embase, and the official website of Health Technology Assessment to query the system review/Meta analysis and and economic research of PPI compared with similar or other antacid/placebo prevention SU. The measurement tool to assess systematic reviews and Consolidated Health Economic Evaluation Reporting Standards scales were used to evaluate the quality of literatures, and the results  were qualitatively analyzed. Results A total of 18 systematic reviews/Meta-analysis and 9 pharmacoeconomic studies were included in this study. The quality of the included literature was good, with scores ranging from 8 to 9. In terms of effectiveness, in intensive care unit, perioperative period, SU, patients with high risk of ulcers and cerebrovascular diseases, the effect of PPI was better than H2 receptor blocker and placebo; the prophylactic effect in patients with chronic renal disease and acute myocardial infarction was better than placebo. In terms of the impact on mortality, compared with the control group, patients with cerebrovascular disease had better mortality reduction with PPI, while there was no significant difference in mortality reduction among acute myocardial infarction, SU and intensive care unit patients among PPI and other drugs(P>0.05). In terms of safety, PPI significantly increased the risk of Clostridium difficile infection, and there was no significant difference in pneumonia compared to the control group (P>0.05). In terms of economy, PPI was less economical than H2 receptor blocker in preventing SU. Conclusion Prophylactic use of PPI can reduce bleeding caused by SU in high-risk patients, but its safety and economy are worse than other antacids.