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非选择性非甾体类抗炎药的不良反应概述

Author
Daniel H Solomon, MD, MPH
Section Editor
Daniel E Furst, MD
Deputy Editor
Paul L Romain, MD
Translators
赵宁民, 副主任药师

引言

每天有超过1700万的美国人使用各种非甾体类抗炎药(nonsteroidal antiinflammatory drug, NSAID)，使这一类药物成为全球最常用的药物之一(表 1)。美国疾病预防控制中心预测，随着人群的老龄化，引起疼痛的退行性和炎症性风湿性疾病的患病率将会显著增加。这将可能导致NSAID的使用也相应增加。

NSAID在老龄人群中的应用增加，将使应用NSAID相关的不良事件数量增加。据估计，有5%-7%的住院与药物不良反应有关，在这些住院治疗中，11%-12%是由非阿司匹林类NSAID对胃肠道、神经系统、肾脏的影响或过敏反应引起的[1,2]。

应用既可抑制环氧合酶(cyclooxygenase, COX)-1、也可抑制COX-2的非选择性NSAID后可能发生的副作用，将总结在此。选择性COX-2抑制剂相关的副作用将单独讨论。 (参见“选择性COX-2抑制剂概述”和“选择性COX-2抑制剂的心血管不良反应”)

概述

NSAID的许多毒性作用与这类药物的主要作用模式有关，其主要作用模式是抑制前列腺素合成。虽然这一问题因为发现至少有两种形式的COX而变得更复杂，但现有的所有非选择性NSAID通常对COX的两种亚型都有抑制作用。 (参见“非甾体类抗炎药：作用机制”)

因此，很难指定“最安全的”的NSAID。许多医生认为布洛芬非常安全，该药在使用最低的可能剂量时确实如此。然而，增加任何NSAID的剂量，都可引起胃肠道毒性风险增加。

                          

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Literature review current through: 2017-06 . | This topic last updated: 2016-09-20.
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