非甾体抗炎药物导致上消化道损伤的危险因素分析

Risk factors of upper gastrointestinal injury induced by non-steroidal anti-inflammatory drugs

目的探讨非甾体抗炎药（NSAIDs）导致上消化道损伤的危险因素。方法回顾NSAIDs使用患者1032例，按2周内是否出现上消化道损伤分为药物不良反应组（331例）和对照组（701例），比较两组患者临床及辅助检查资料、用药情况等。结果两组患者年龄〉65岁、幽门螺杆菌（Hp）感染、溃疡病史、用药剂量过大、合用糖皮质激素、嗜烟酒史、非特异性环氧合酶（cox）．2抑制剂、合用抗凝剂、伴随慢性心肺疾病比较差异有统计学意义（P〈0．05）。用向后删除法进行多因素非条件Logistic回归分析，保留在模型中的变量有合用糖皮质激素（0尺值3．104，95％讲1．936～4．695）、Hp感染（OR值2．768，95％CI2．047～3．742）、用药剂量过大（OR值2．411，95％CI1.683—3．453）、溃疡病史（OR值1．781，95％CI1．278～2．480）、年龄〉65岁（OR值1．659，95％CI1．237—2．225）、非特异性COX．2抑制剂（OR值1．470，95％CI1．103～2．133）、嗜烟酒史（OR值1．459，95％CI1．032～2．064）、伴随慢性心肺疾病（DR值1．357，95％CI 1．008～2．143），其P值均〈0．05。结论合用糖皮质激素、Hp感染、用药剂量过大、溃疡病史、年龄〉65岁、非特异性COX．2抑制剂、嗜烟酒史、伴随慢性心肺疾病是NSAIDs导致上消化道损伤的危险因素。

Objective To investigate the risk factors of upper gastrointestinal injury induced by non-steroidal anti-inflammatory drugs （NSAIDs）. Methods A total of 1032 patients which used NSAIDs was selected. Patients were divided into two groups based on the condition of dyspepsia, peptic ulcer or upper gastrointestinal bleeding： the adverse drug reaction group （331 cases） and the control group （701 cases）. Data of two groups on clinical presentation, laboratory test, medication and treatment were analyzed. Risk factors for the adverse drug reaction were identified by multivariable Logistic regression. Results The two groups had significant difference in age 〉 65 years old, Helicobacter pylori （Hp） infection, ulcer history, drug overdose, combination with glucocorticoid, addicted to tobacco and alcohol history, non-specific inhibitor of cyclooxygenase（COX）-2, combination with anticoagulant, concomitant chronic cardiopulmonary disease （P 〈 0.05）. Logistic regression analysis by backward elimination method revealed that following variables retained , such as combination with glucocorticoid （OR = 3.104,95% CI 1.936 -4.695）, Hp infection （OR = 2.768,95% CI 2.047 - 3.742）, drug overdose （OR = 2.411,95% CI 1.683 - 3.453）, ulcer history （OR = 1.781,95% CI 1.278 - 2.480）, age 〉65 years old （OR = 1.659,95% CI 1.237 - 2.225）,non-specific inhibitor of COX-2 （OR = 1.470,95% CI 1.103 - 2.133）, addicted to tobacco and alcohol history （OR = 1.459,95% CI 1.032 -2.064）, concomitant chronic cardiopulmonary disease （OR = 1.357,95% CI 1.008 - 2.143）,P 〈 0.05. Conclusion Combination with glucocorticoid, Hp infection, drug overdose, ulcer history, age 〉 65 years old, non-specific inhibitor of COX-2, addicted to tobacco and alcohol history, concomitant chronic cardiopulmonary disease are risk factors of upper gastrointestinal injury induced by NSAIDs.