急性冠脉综合征胃肠出血危险因素的研究

Risk factors of gastrointestinal bleeding in patients with acute coronary syndrome

目的:探索急性冠脉综合征(ACS)患者发生胃肠出血的主要危险因素。方法:回顾性分析我院2003年～2011年诊断为ACS的3 642例患者的临床资料,根据是否发生胃肠道出血分为胃肠道出血组(90例)和无胃肠道出血组(3 552例),比较两组临床资料,并分析其胃肠出血的危险因素。结果:胃肠出血者死亡率较无胃肠出血者明显升高(33.7%比4.6%,P<0.001)。与无胃肠出血者比较,胃肠出血组年龄明显偏高[(62.4±13.5)岁比(68.2±12.3)岁],女性患者较多(41.8%比57.8%),胃肠疾病史、心脏停搏、肾功能不全、PCI术、心力衰竭、糖尿病、高血压病、合用替罗非班比率明显升高(P<0.05～0.01),肌钙蛋白T峰值明显升高[(82±146)ng/ml比(139±168)ng/ml,P<0.01]。多元Logistic回归分析显示,胃肠道出血的危险因素为:年龄,女性,胃肠疾病史,肌钙蛋白T峰值,心脏停搏,肾功能不全,PCI术,心力衰竭(OR=1.01～3.18,P均<0.01)。结论:ACS患者发生胃肠出血的主要危险因素是:年龄>65岁,女性,PCI术,心脏停搏,肾功能不全,胃肠疾病史,肌钙蛋白T峰值,心力衰竭。ACS患者合并胃肠出血的患者住院死亡率明显增加,需要重视其预防和治疗。

Objective： To investigate main risk factors of gastrointestinal bleeding （GB） in patients with acute coro- nary syndrome （ACS）. Methods： Clinical data of 3 642 patients diagnosed as ACS in our hospital from 2003 to 2011 were retrospectively analyzed. According to GB or not, patients were divided into GB group （n = 90） and no-GB group （n = 3552）, clinical data were compared between two groups and risk factors of GB were analyzed. Results： Compared with no-GB group, there were significant increase in mortality rate （4.6% vs. 33. 7%, P0. 001）, age [ （62.4 ± 13.5） years vs. （68.2 ± 12.3） years], percentages of female （41.8% vs. 57. 8%）, patients with gastroin- testinal disease history, cardiac arrest, renal dysfunction, PCI, heart failure, diabetes mellitus, hypertension, com- bined use of tirofiban and troponin T peak level [ （82 ± 146） ng/ml vs. （139± 168） ng/ml] （P〈0.05-0.01） in GB group. Multiple Logistic regression analysis indicated that risk factors of GB were age, female, gastrointestinal dis- ease history, troponin T peak, cardiac arrest, renal dysfunction, PCI and heart failure （OR= 1.01-3.18, P〈0.01 all）. Conclusion： Main risk factors of GB in ACS patients are age 〉65 years, female, PCI, cardiac arrest, renal dysfunction, gastrointestinal disease history, troponin T peak and heart failure. In-hospital mortality rate signifi- cantly increases in ACS patients with GB, therefore need to pay attention to prevention and treatment for improving prognosis.