不明原因消化道出血患者临床再出血危险因素分析

Risk factors of rebleeding in patients with obscure gastrointestinal bleeding

目的寻找并分析不明原因消化道出血（OGIB）者再出血的相关危险因素，以降低再出血率，提高患者生活质量。方法选取2002年6月至2010年10月间因不明原因消化道出血行胶囊内镜（CE）检查并有随访数据的患者307例，查阅搜集患者住院病史等资料，以再出血作为研究的主要终点事件来评估患者预后，通过单因素与多因素分析探究与再出血相关的危险因素。结果随访13—112个月，中位时间52个月。CE阳性发现202例（65．8％），总再出血率28％（86／307）。CE检查阳性患者再出血率高于阴性患者（37．6％比9．5％，P=0．000）。接受特异性治疗的患者再出血率低于接受非特异性治疗患者（32．9％比23．0％，P=0．042）。95．3％（82／86）的再出血发生于CE检查后24个月内。经COX比例风险模型多因素分析显示CE检查阳性、CE后使用抗凝药物或抗血小板药物或NSAIDs药、年龄i〉50岁、高血压、CE前3个月内最低血红蛋白≤7g/dL、CE后未能接受特异性治疗是再出血率增加的6个独立危险因素。结论临床医师注意防范与OGIB患者再出血率增加相关的危险因素，将有助于降低再出血率，避免不必要的重复检查。对于再出血高危OGIB患者．CE后府军，珍密切随访24个月．

Objective To investigate the long-term（ 〉 1 year） rebleeding rate after capsule endoscopy （CE）-guided intervention in patients with obscure gastrointestinal bleeding （OGIB） and to identify the risk factors of rebleeding. Methods A total of 307 consecutive patients who underwent CE for OGIB in our hospital from June 2002 to October 2010 were enrolled. Follow-up data were obtained by reviewing medical records, CE database and contacting the patients or their relatives by telephone. We evaluated the rebleeding rates and analyzed risk factors predictive of rebleeding by means of COX ratio hazard model. Results The medium follow-up was 52 months （rangel3-112 months）. Significant lesions were found in 202 patients （65.8%）. The overall rebleeding rate after interventional therapy induced by CE findings was 28.0% （86/307）. CE positive patients had higher rebleeding rate than CE negative patients （37.6% vs 9. 5%, log-rank test, P = 0. 000）, while specific therapy could prevent rebleeding, compared with nonspecific therapy （32. 9% vs 23.0%, P =0. 042）. 95.3% （82/86） rebleeding occurred within 24 months after CE. Multivariate analysis performed by using COX proportional hazards model showed that age over 50 years, CE positive findings, lowest hemoglobin （Hb） level 3 months before CE ≤7 g/dl, receiving nonspecific therapy after CE, hypertension, administration of anticoagulants, antiplatelet medicine or NSAIDs after CE were six risk factors associated with rebleeding. Conclusion Clinicians should be aware of these risk factors for OGIB rebleeding, which can reduce the occurrence of rebleeding and improve OGIB patients＇ prognosis. Those high risk OGIB patients should be followed up for at least 24 months after CE.