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JGH:阿米替林治疗小儿功能性腹痛疾病的疗效分析

2021-12-23 MedSci原创 MedSci原创

阿米替林是传统抗抑郁药三环类抗抑郁药中的一种,该药能够阻滞去甲肾上腺素和五羟色胺再摄取,还有胆碱能M1受体、去甲肾上腺素能a1和H1受体阻断作用。

临床上所谓的功能性腹痛,就是指患者没有器质性的腹部疾病,腹部疼痛一般是由于神经功能调理不好,导致的肠道扩张或者收缩功能障碍出现的疼痛。阿米替林(Amitriptyline)是一种主要用于治疗抑郁或焦虑症的三环类抗抑郁药。与其它三环类药物一样,阿米替林也有一些潜在副作用和禁忌。但是最近有研究显示其在治疗小儿功能性腹痛疾病 (FAPD) 方面具有很好的疗效。但在儿科研究中结果不一。该研究旨在评估阿米替林在儿科 FAPD 中的疗效。

 

研究人员根据罗马 IV 标准,将诊断为 FAPD 的儿童(≤18 岁)随机接受阿米替林或安慰剂治疗 12 周。然后比较两组患者接受治疗后疼痛和生活质量(QOL)的改善情况。

 

研究结果显示本项研究中的149 名儿童(阿米替林 75 名,安慰剂 74 名)的平均年龄为 11.3±3.5 岁(79 名为男性)。阿米替林和安慰剂在腹痛强度(3.4 VS 0.9)、腹痛频率(3.6 VS 0.6)、腹痛持续时间(3.5 VS 0.9)和 QOL(2.3 VS 0.9)的评分降低方面存在显着差异。阿米替林组有 76% 的患者疼痛缓解(>50% 减少),而安慰剂组只有 14.9%(p<0.001)。在多变量分析中,阿米替林的使用是唯一预测腹痛改善的因素(OR 24.1,95% CI:9.1-64.6,p<0.001)。组间轻微不良事件具有可比性(25.3% vs. 13.5%,p=0.07)。89% 延长治疗时间(6.8±1.8 个月)的儿童 (24/27) 疼痛得到改善。停用阿米替林后,70% 的患者在平均随访 15.84±5.6 个月内获得持续缓解。

在这项为期三个月的阿米替林试验中 ,作者证实阿米替林可以持续缓解至少三分之二的 FAPD 儿童的腹部疼痛。该药物的安全性及其功效需要在临床环境中进行进一步检验。

原始出处:

Jayendra Seetharaman. Et al. Efficacy of amitriptyline in Pediatric Functional abdominal pain disorders: A randomized placebo-controlled trial.  Journal of Gastroenterology and Hepatology.2021.

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    应性皮炎(AD)是一种慢性炎症性瘙痒

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