双联抗血小板治疗合并上消化道出血的危险因素

Risk factors for upper gastrointestinal bleeding in patients receiving dual antiplatelet therapy

目的:探讨双联抗血小板治疗合并上消化道出血(upper gastrointestinal bleeding,UGIB)的危险因素,为相关的预防策略的制定提供依据.方法:收集天津市第四中心医院2010-01/2013-12收治的双联抗血小板治疗合并UGIB住院患者59例为观察组,随机选取同期双抗血小板治疗的冠心病而无UGIB患者240例作为对照组,经Logistic回归分析,确定相应的危险性因素.结果:经L o g i s t i c回归分析结果显示:急性冠脉综合征(O R=3.47,95%C I:1.77-6.81)、UGIB病史(OR=8.93,95%CI:1.72-46.39)、消化性溃疡病史(O R=4.19,95%C I:1.67-10.72)、慢性肾功能不全(O R=5.19,95%C I:1.49-18.03)和幽门螺杆菌(Helicobacter pylori,H.pylori)(OR=6.67,95%C I:3.02-14.73)是双联抗血小板治疗合并UGIB的危险因素,质子泵抑制剂可以降低出血风险.结论:UGIB病史、消化性溃疡史、急性冠脉综合征、慢性肾功能不全和H.pylori是双联抗血小板治疗合并UGIB的危险因素,质子泵抑制剂可以降低出血风险.临床工作中应注意识别UGIB高危因素,预防UGIB发生.

AIM：To investigate the risk factors for upper gastrointestinal bleeding（UGIB） in patients receiving dual antiplatelet therapy.METHODS：From January 2010 to December2013,59 hospitalized patients who were diagnosed with UGIB and received dual antiplatelet therapy at our hospital were included as an observation group,and 240 patients with coronary artery disease receiving dual antiplatelet therapy during the same period but without UGIB were selected randomly as a control group.The risk factors for UGIB were identified by Logistic regression analysis.RESULTS：Logistic regression analysis showed that acute coronary syndrome（OR =3.47,95%CI：1.77-6.81）,history of UGIB（OR =8.93,95%CI：1.72-46.39）,history of peptic ulcer（OR = 4.19,95%CI：1.67-10.72）,chronic renal insufficiency（OR = 5.19,95%CI：1.49-18.03）,and Helicobacter pylori infection（OR = 6.67,95%CI：3.02-14.73） were associated with a high risk for developing UGIB.The use of proton pump inhibitor therapy had a protective role in these patients（OR = 0.07,95%CI：0.01-0.50）.CONCLUSION：History of UGIB,acute coronary syndrome,history of peptic ulcer,chronic renal insufficiency and Helicobacter pylori infection are important risk factors for UGIB.The use of proton pump inhibitor plays a protective role in patients with coronary artery disease receiving dual antiplatelet therapy.