非甾体抗炎药相关小肠黏膜损害的临床表现及内镜下特点探讨

Clinical manifestations and endoscopic features of non-steroidal anti-inflammatory drugs-induced small intestinal mucosa damage

目的探讨非甾体抗炎药(NSAIDs)相关小肠黏膜损害患者的临床表现及内镜下特点,为其诊疗提供依据。方法收集2013年1月~2017年12月因不明原因消化道出血就诊于我院且有NSAIDs使用史的患者171例,最终确诊为NSAIDs相关小肠黏膜损害病例110例,收集其临床资料,并进行分组比较和回顾性分析。结果使用NSAIDs患者小肠黏膜损害的发生率为64.3%;消化道出血[100.0%,包括黑便(65.9%)及血便(34.1%)]为最常见临床表现。年龄≥60岁及持续用药时间>3个月的患者小肠黏膜损害的发生率更高(P<0.05)。内镜下特点以黏膜糜烂(71.8%)最为常见,空肠糜烂及黏膜下出血发生率高于回肠,溃疡发生率低于回肠(P<0.05)。使用非阿司匹林NSAIDs患者比使用低剂量阿司匹林患者更易发生溃疡(P<0.05)。结论使用NSAIDs患者中,老年及长期持续用药患者更易出现小肠黏膜损害,诊断需结合用药史及内镜检查等进行。对于长期使用非阿司匹林NSAIDs患者应警惕回肠溃疡的发生。

Objective To explore the clinical manifestations and endoscopic features of patients with non-steroidal anti-inflammatory drugs (NSAIDs)-induced small intestinal mucosa damage and to provide evidence for their diagnosis and treatment.Methods A total of 171 patients who came to our hospital due to obscure gastrointestinal bleeding from January 2013 to December 2017 and had a history of NSAIDs administration were enrolled.NSAIDs-induced small intestinal mucosa damage were eventually diagnosed in 110 patients.Their clinical data were collected,and group comparison and retrospective analysis were conducted.Results The rate of small intestinal mucosa damage in NSAIDs patients was 64.3%,and digestive tract hemorrhage [100.0%,including melena (65.9%)and bloody stool (34.1%)]was the most common manifestation.Patients with the age ≥60 years old and those who took the drug continuously for longer than 3 months were more likely to have small intestinal mucosa damage (P <0.05 ).Erosive lesions (71.8 %)was the most common feature of endoscopy.The occurrence rates of erosive lesions and submucosal hemorrhage were higher than those in the jejunum,whlie the occurrence rate of ulcers was lower than that in the ileum (P <0.05 ).Patients taking non-aspirin NSAIDs were more likely to have ulcers than those taking low-dose aspirin (P <0.05 ).Conclusion NSAIDs-induced intestinal damage is more common in the elderly and people who have been on sustained medication for a long time.However,the diagnosis should be combined with medical history and endoscopy etc,because of atypical clinical manifestations.In addition,it should be aware of ileal ulcers in people with long-term use of non-aspirin NSAIDs.