臨床常用藥10種鮮為人知的用途

導讀：近年來，研究者經常會發現部分老藥還有一些新用途和驚人的益處。華盛頓大學醫學教授Douglas Paauw博士總結了7種藥物的10種用途。

作者:醫脈通

來源:醫脈通心內頻道ID:medlive-Cardiology

盡管每年都有數十種新藥上市，但我們也不能忘了那些「久經考驗」的老藥。近年來，研究者經常會發現部分老藥還有一些新用途和驚人的益處。華盛頓大學醫學教授Douglas Paauw博士總結了7種藥物的10種用途。來看一下，你都知道嗎？

二甲雙胍：預防癌症，改善其預後

二甲雙胍是最常用的口服降糖藥物，有效，成本低，低血糖風險極低，對體重的影響是中性的。多項研究提出了它的另一個可能的獲益——降低癌症的發病率和死亡率。

一項納入超過20,000名女性2型糖尿病患者的巢式病例對照研究得出結論，使用二甲雙胍超過5年與乳腺癌風險降低相關（OR 0.44; 95%CI 0.24-0.82）。

2017年發表的一項Meta分析納入了9,000名服用二甲雙胍的患者，結果顯示結直腸腺瘤風險降低（pooled OR, 0.76; 95% CI, 0.63-0.92）。

二甲雙胍還可能減緩某些癌症的進展並提高其生存率，包括頭頸部、卵巢、胰腺和肺部的腫瘤。

不過這種效應在動物模型或流行病學研究中尚未得到一致的證實，目前正在對二甲雙胍潛在的抗腫瘤作用進行大量的研究。

氯沙坦：降尿酸作用

對於高血壓合併高尿酸血症的患者，服用氯沙坦除了降壓還能降低血尿酸。氯沙坦具有鹼化尿液的作用，可以增強尿酸排泄，降低尿酸結晶形成的風險。一項基於人群的病例對照研究發現，使用氯沙坦與痛風事件風險降低相關。

氯沙坦是唯一的顯示尿酸水平顯著降低的ARB類藥物，對高尿酸血症患者是安全有效的。

噻嗪類利尿劑：預防骨質疏松性骨折

噻嗪類利尿劑可減少尿鈣排泄，改善骨密度。在Framingham研究中，噻嗪類藥物使用者的髖部骨折風險降低。其後的多項隨機試驗表明，噻嗪類利尿劑可維持骨密度。

在選擇降壓藥物時，噻嗪類藥物的這種益處值得考慮。

螺內酯：用於心衰和難治性高血壓

RALES試驗發現，對於左心室收縮功能障礙所致的嚴重心力衰竭患者，螺內酯聯合標準治療可顯著降低並發症和死亡風險。

在過去10年中，螺內酯在治療難治性高血壓方面發揮了更大的作用。

螺內酯：抗雄激素作用

由於其抗雄激素作用，螺內酯也被用於女性多毛症、女性脫髮、痤瘡和多囊卵巢綜合征（PCOS）皮膚改變的治療。

關於多毛症和PCOS的證據最強，治療痤瘡和女性脫髮的作用主要來自一些陽性研究和臨床經驗。

螺內酯：用於骨關節炎

螺內酯可阻斷醛固酮。最近的兩項研究評估了該藥在骨關節炎中的潛在的治療效果。

一項前瞻性隨機研究納入了200名符合美國風濕病學會膝關節骨性關節炎標準且存在新發膝關節積液的患者，結果顯示，低劑量螺內酯組有66%的患者積液完全消失，效果優於布洛芬、冰和安慰劑。

但另一項針對老年人骨關節炎引起膝關節疼痛的隨機、雙盲、安慰劑對照得出結論，該藥並未改善疼痛和身體功能。

硝酸甘油：外用，治療肛裂

硝酸甘油最常用於預防或治療心絞痛。外用硝酸甘油可以治療肛裂。肛門括約肌壓力高會減少該部位的血流量，局部使用硝酸甘油可以通過降低壓力改善血流量。

2011年，美國食品和藥品管理局（FDA）批准0.4%的硝酸甘油軟膏用於治療慢性肛裂的中重度疼痛。

硝酸甘油：外用，用於網球肘

局部硝酸甘油也被證明是治療肱骨外上髁炎（俗稱「網球肘」）的有效方法。一項隨機對照試驗中，局部使用硝酸甘油治療成功率高達90％，6個月隨訪仍然效果顯著。已經證實，使用硝酸甘油貼劑可減輕肱骨外上髁炎的疼痛症狀並改善功能。

最近的系統評價發現，局部使用硝酸甘油6個月也可能是肌腱病的有效輔助治療方法。

加巴噴丁：治療慢性咳嗽

慢性咳嗽通常很難治療。90%的慢性咳嗽患者有上呼吸道咳嗽綜合征、哮喘、非哮喘性嗜酸細胞性支氣管炎或胃食管反流病。針對這些疾病，咳嗽抑制劑幾乎沒有有效性證據；而神經調節劑加巴噴丁已被證明可以降低咳嗽頻率並改善生活質量。

一項為期10周的安慰劑對照、隨機、雙盲試驗納入62名頑固性慢性咳嗽（持續超過8周）患者，發現加巴噴丁顯著改善了咳嗽相關的生活質量，NNT 3.58。最新的慢性咳嗽指南認可了加巴噴丁用於慢性咳嗽是恰當的治療選擇。

甲氧氯普胺：用於偏頭痛

抗多巴胺能藥物甲氧氯普胺是急性偏頭痛治療的有效選擇。部分偏頭痛患者發作時表現為胃輕癱，可出現惡心等症狀。甲氧氯普胺可改善胃輕癱，並促進口服藥物的吸收，作為偏頭痛的輔助治療藥物。

一項針對曲坦類藥物無反應患者進行的隨機、雙盲、交叉研究顯示，單獨使用舒馬曲坦治療偏頭痛的緩解率為31％，而甲氧氯普胺聯合舒馬曲坦治療的緩解率為63％。近期一篇急診科偏頭痛治療的綜述認為，甲氧氯普胺應該比阿片類藥物更頻繁地用於急性偏頭痛的一線治療。(原標題：老樹新花，臨床常用藥的10種鮮為人知的用途)

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醫脈通編譯自：Douglas S. Paauw. 10 Little Known Uses for Common, Everyday Drugs. Medscape. December 3, 2018