中国上消化道出血的临床流行病学分析

Clinical epidemiologic study of upper gastrointestinal bleeding in China

目的探讨中国上消化道出血的病因构成、临床特点及相关因素，探讨特殊人群的病因构成。方法运用循证医学方法，检索中文数据库中有关上消化道出血病因相关分析的文献并获取全文，根据严格的纳入和排除标准对文献进行筛选，然后进行数据提取、汇总及分析。结果（1）此项研究共纳入上消化道出血患者15733例；（2）十二指肠球部溃疡、胃溃疡、急性胃黏膜病变、恶性肿瘤、食管静脉曲张是中国上消化道出血的主要病因，分别占31．2％、15．2％、12．0％、11．7％、11．3％；（3）2000至2006年与2006至2011年相比，十二指肠球部溃疡、胃溃疡、急性胃黏膜病变、食管静脉曲张、恶性肿瘤的构成比分别是32．3％、15．1％、12．1％、7．2％、12．5％及29．7％、15．4％、11．1％、15．3％、10．9％；（4）男性患者明显多于女性患者，比例为3．25：1；（5）老年人上消化道出血的主要病因依次为胃溃疡、恶性肿瘤、急性胃黏膜病变、十二指肠球部溃疡、食管静脉曲张，小儿上消化道出血的主要病因依次为十二指肠球部溃疡、胃溃疡、急性胃黏膜病变。结论消化性溃疡、急性胃黏膜病变、恶性肿瘤、食管静脉曲张是中国上消化道出血的主要病因。近5年上消化道出血的病因构成有明显变化。

Objective To investigate the etiology, characteristics of upper gastrointestinal bleeding （UGIB） in China, and to investigate the main causes of different population. Methods Literature on the causes of UGIB were retrieved and screened according to strict inclusion and exclusion standards. Results A total of 15 733 UGIB patients were enrolled in the study. The most common causes of UGIB were duodenal ulcer （31.2%） , gastric ulcer （ 15.2% ） , acute gastric mucosal lesions （AGML） （ 12. 0% ） , cancer （11.7%）, and esophageal varices （11. 3% ）. The incidences of duodenal ulcer, gastric ulcer, AGML, esophageal varices, cancer were 32. 3% , 15.1% , 12. 1% , 7. 2% , and 12. 5% before 2006, and 29.7% , 15.4%, 11.1%, 15.3%, and 10. 9% after 2006. The ratio of male to female was 3.25 ： 1. The most com- mon causes of UGIB in older patients were gastric ulcer, cancer, AGML, duodenal ulcer,esophageal vari- ces, while those in children were duodenal ulcer, gastric ulcer and AGML. Conclusion Peptic ulcers, AGML, cancer and esophageal varices were the most common causes of UGIB in China. The causes of UGIB have changed significantly in the past 5 years （P 〈 0. 01 ）.