Влияют ли глюкокортикоиды на развитие язв и эрозий верхних отделов желудочно-кишечного тракта у больных, принимающих НПВП?

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Аннотация

Использование глюкокортикоидов (ГК) считается одним из факторов риска развития осложнений со стороны желудочно-кишечного тракта (ЖКТ), возникающих на фоне приема нестероидных противовоспалительных препаратов (НПВП). Однако данные по этому вопросу противоречивы.
Цель исследования. Оценить частоту выявления язв и эрозий у больных ревматическими заболеваниями (РЗ), получающих НПВП, в зависимости от сопутствующего приема ГК.
Материалы и методы. У больных РЗ проведено ретроспективное сравнение частоты изменений ЖКТ, выявленных при проведении эндоскопического исследования в одном медицинском центре за период 2007 – 2016 гг. Сформированы 3 группы: в группе 1 больные принимали только НПВП (n=4823, женщины 80,7%, возраст 51,1 ± 15,4 года), в группе 2 – больные принимали НПВП и ГК (n=1608, женщины 89,8%, возраст 50,4 ± 14,6 года), в группе 3 – больные принимали только ГК (n=1135, женщины 92,7%, возраст 44,1 ± 15,3 года). Оценивали выявление множественных эрозий (>10, МЭ) и язв желудка и/или двенадцатиперстной кишки.
Результаты. Частота МЭ и язв у больных групп 1 и 2 достоверно не различалась: 10,5% и 8,5%, отношение шансов 0,799 (95% доверительный интервал 0,546–1,169, р=0,072). Факторы риска, такие как возраст 65 лет и более, язвенный анамнез и прием низких доз аспирина, не влияли на данную закономерность. Частота МЭ и язв оказалась достоверно ниже у больных группы 3, чем в группах 1 и 2: 6,3% (р<0,001, р=0,032).
Заключение. Использование ГК не повышает риск развития эрозий и язв верхних отделов ЖКТ при приеме НПВП.

Ключевые слова: НПВП, глюкокортикоиды, НПВП-гастропатия, факторы риска, эрозии желудка, язвы желудка.

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The use of glucocorticoids (GC) is considered one of the risk factors for the development of gastro-intestinal (GI) complications associated with the use of non-steroidal anti-inflammatory drugs (NSAIDs). However, the data on this issue are contradictory.
Objective. To assess the frequency of ulceration and erosion in patients with rheumatic diseases (RD) receiving NSAIDs, depending on the concomitant use of GC.
Materials and methods. A retrospective comparison was made of the incidence of gastrointestinal lesions detected in patients with RD during endoscopic examination in one medical center for 2007–2016. Three groups were formed: in group 1 patients took only NSAIDs (n=4823, women 80.7%, age 51.1 + 15.4 years), in group 2 patients took NSAIDs and GC (n = 1608, women 89, 8%, age 50.4 + 14.6 years), in group 3 – only patients took GC (n=1135, women 92.7%, age 44.1 + 15.3 years). The detection of multiple erosions (>10, ME) and gastric and / or duodenal ulcers was as-sessed.
Results. The frequency of ME and ulcers in patients of groups 1 and 2 did not differ significantly: 10.5% and 8.5%, odds ratio 0.799 (95% confidence interval 0.546-1.169, p=0.072). Risk factors, such as age > 65 years, ulcer history and low-dose aspirin, did not affect this pattern. The incidence of ME and ulcers was significantly lower in Group 3 patients than in Groups 1 and 2: 6.3% (p<0.001, p=0.032).
The conclusion. The use of GC does not increase the risk of erosion and ulcers of the upper GI tract when taking NSAIDs.

Keywords: NSAID, glucocorticoids, NSAID-gastropathy, risk factors, gastric erosion, stomach ulcer.

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Авторы

А.Е. КАРАТЕЕВ 1, Е.В. МОРОЗ 2

1 ФГБНУ «Научно-исследовательский институт ревматологии им. В.А. Насоновой», Москва, Россия;
2 ФГКУ «Главный военный клинический госпиталь им. академика Н.Н. Бурденко» МО РФ, Москва, Россия

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A.E. Karateev 1, E.V. Moroz 2

1 V.A. Nasonova Research Institute of Rheumatology, Moscow, Russian;
2 N.N. Burdenko Main Military Clinical Hospital of the Ministry of Defense, Moscow, Russian

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