非甾体抗炎药和幽门螺杆菌感染对消化性溃疡并发出血的影响

The Influence of Non-steroidal Anti-inflammatory Drugs and Helicobacter Pylori in Patients with Bleeding Peptic Ulcer

目的探讨服用非甾体抗炎药(NSAIDs)和幽门螺杆菌(H.pylori)感染与消化性溃疡并发出血的关系。方法收集2007年1月—2009年7月在新疆医科大学第一临床医学院消化内科收治的消化性溃疡患者205例,均行内镜检查确诊(除外复合溃疡),并行病理学检查排除胃癌。对消化性溃疡并发出血的危险因素行单因素和多因素分析。结果205例消化性溃疡患者中,男150例(73.2%),女55例(26.8%);中位年龄49(12～88)岁;并发出血87例(42.4%)。在单因素分析中,出血组与未出血组患者中年龄≥60岁者、既往有消化道出血史者、心脑血管病史者、有多个溃疡者所占比例间差异均有统计学意义(P<0.01);进一步行Logistic逐步回归分析,发现年龄≥60岁、有消化性溃疡史、消化道出血史、心脑血管病史和单纯H.pylori感染、单纯服用NSAIDs、H.pylori感染同时服用NSAIDs为消化性溃疡并发出血的危险因素。结论H.pylori感染并未增加溃疡并发出血的危险性,但与服用NSAIDs、年龄≥60岁、消化性溃疡或出血史、心脑血管病史等因素联合可增加溃疡并发出血的危险性。

Objective To analyze the relationship between non-steroidal anti-inflammatory drugs （NSAIDs） and Helicobacter pylori（H.pylori）in Bleeding peptic ulcer（BPU）.Methods All peptic ulcers （PU） inpatients were diagnosed by endoscopy in our hospital from January 2007 to July 2009 were collected（except complex ulcer）.Gastric carcinoma was excluded by pathologic examination.The risk factors of bleeding in PU patients were analyzed by single factor and multifactor.Results Of the 205 PU cases,including 150 （73.2%） male and 55 （26.8%） female patients.The median age was 49 （12-88） years,bleeding occurred in 87 （42.4%） cases of PU.Univariate analysis identified 5 statistically significant variables,including aged 60 years or older,the history of BPU and cardio-cerebral-vascular diseases,ulcer number and NSAIDs use.Logistic stepwise regression analysis showed that aged 60 years or older,the history of PU or BPU,the history of cardio-cerebral-vascular diseases,H.pylori infection alone,NSAIDs consumption alone and combined H.pylori infection and NSAIDs use were independent risk factors of BPU.Conclusion H.pylori infection was not a risk factor for BPU,but the combination of H.pylori infection and NSAID use,aged 60 years or older,the history of PU or BPU,the history of cardio-cerebral-vascular diseases were associated with an increased risk of BPU.