根除幽门螺杆菌对长期联用阿司匹林和氯吡格雷者上消化道再出血发生率的影响

Effects of eradication of Helicobacter pylori on upper gastrointestinal rebleeding rate in patients with longterm aspirin and clopidogrel combination therapy

【摘要】目的研究H．pylori感染在持续联用阿司匹林和氯吡格雷≥3个月者上消化道再出血中的意义。方法选取2007年9月至2011年9月皖南医学院弋矶山医院确诊为上消化道出血并有阿司匹林和氯吡格雷长期服药史（即持续联合用药时间≥3个月）的患者78例，予其埃索美拉唑治疗。入选患者经快速尿素酶试验和胃黏膜组织吉姆萨染色病理检查后显示，55例患者H．pylori感染阳性（阳性组），余23例则归人阴性组。阳性组经随机分配表法再分为干预组（28例）和对照组（27例）。干预组接受根除H．pylori治疗，并以“C呼气试验检查H．pylori的根除情况。所有患者在完成所有治疗后均随访6个月，观察患者的临床表现和再出血情况。分类变量资料以百分率表示，分别进行意向性分析和符合方案集分析，并行卡方检验。结果阴性组中1例胃癌患者退出研究，干预组中2例患者失访，对照组中l例患者失访。干预组H．pylori均获根除。在符合方案集分析中，干预组和对照组的再出血率[分别为7．69％（2／26）和34．62％（9／26）]比较差异有统计学意义（x2=5．650，P=0．017），阴性组[-18．18％（4／22）]与干预组、阴性组与对照组间比较差异均无统计学意义（P均〉0．05）。在意向性分析中，干预组和对照组的再出血率[分别为7．14％（2／28）和33．33％（9／27）1比较差异有统计学意义（x2=5．893，P=0．015），阴性组[17．39％（4／23）]与干预组、阴性组与对照组间比较差异均无统计学意义（P均〉0．05）。结论根除H．pylori或能有效降低长期联用阿司匹林和氯吡格雷者上消化道再出血的发生率。

Objective To investigate the significance of H. pylori infection on upper gastrointestinal rebleeding in patients with long-term （≥ three months） aspirin and clopidogrel combination therapy. Methods From September 2007 to September 2011, at Yijishan Hospital of Wannan Medical College 78 patients with upper gastrointestinal bleeding and receiving long-term （≥three months） aspirin and clopidogrel combined therapy were selected and treated with esomeprazole. The results of rapid urease test and gastric mucosal biopsy Giemsa staining of selected patients indicated 55 patients were H. pylori positive （positive group） and the other 23 cases were in negative group. The patients of positive group were randomly divided into intervention group （28 cases） and control group （22 cases） by the random allocation table method. The patients of intervention group received H. pylori eradiation treatment and the situation of H. pylori eradication was checked by 14C breath test. After treatment all patients were followed up for six months and clinical symptoms and the situation of rebleeding were observed. Categorical variables were expressed as percentage, intentional analysis and in accordance with protocol analysis were performed separately and analyzed by chi-square test. Results One patient in negative group with gastric cancer withdraw from the study. Two patients in intervention group lost. And one patient in control group lost. H. pylori of intervention group was all eradiated. In accordance with protocol analysis, the rebleeding rates of intervention group and control group were 7. 69% （2/26） and 34.62% （9/26）, respectively, and the difference was statistically significant （x2 = 5. 650, P = 0. 017）. There was no significant difference between negative group （18.18%, 4/22） and intervention group and no significant difference between negative group and control group （both P 〉 0. 05）. In intentional analysis, the rebleeding rates of intervention group and control group were 7. 14% （2/28） and 33. 33% （9/27）, respectively, and the difference was statistically significant （X2 = 5. 893, P = 0. 015）. There was no significant difference between negative group （17.39%, 4/23） and intervention group and no significant difference between negative group and control group （both P 〉 0. 05 ）. Conclusion Eradication of H. pylori can reduce the rate of upper gastrointestinal rebleeding in patients with long-term aspirin and clopidogrel combination therapy.