冠心病患者择期PCI术后消化道大出血的危险因素

Predictive risk factors for massive gastrointestinal hemorrhage in patients with coronary artery disease after elective percutaneous coronary intervention

目的：研究冠心病患者择期经皮冠状动脉介入治疗（ PCI）术后消化道大出血（ MGH）的发生率及危险因素。方法连续入选2012年1月至2014年12月期间在首都医科大学附属北京安贞医院心血管内科行择期PCI的非ST段抬高型急性冠脉综合征患者4239例。根据择期 PCI 术后1年内是否发生 MGH 分为两组：MGH 组（ n ＝47）和非 MGH 组（n＝4192）。对比两组患者的临床资料及随访1年后的MGH事件及死亡率。结果随访1年，MGH的发生率为1．11％（47／4239）。 MGH组患者术前使用华法林和低分子肝素的比例显著高于非MGH组（ P＜0．05）。多元logistic回归分析显示，冠心病择期PCI患者术后MGH的独立危险因素为＞75岁（OR＝1．25，P＝0．031）、贫血（OR＝1．18，P＝0．037）、消化道出血史（OR＝1．49，P＝0．005）和慢性肾功能不全（OR＝2．27，P＝0．001）。随访1年后，MGH组患者的死亡率显著高于非MGH组（6.4％vs 3．2％，P＜0．001）。结论使用抗血小板聚集药物时应根据患者的年龄、体质量和肾功能调整药物类型和剂量，并注意积极纠正贫血和保护肾功能。

Objective To investigate the incidence and risk factors of massive gastrointestinal hemorrhage （MGH） in the patients with coronary artery diseases treated with elective percutaneous coronary intervention （ PCI ） .Methods Consecutive 4239 patients with non-ST elevation acute coronary syndrome successfully treated with elective PCI in Anzhen Hospital from January 2012 to December 2014 were enrolled in this study .According to the occurrence of MGH or not within 1 year after PCI , the subjects were divided into MGH group （ n =47 ） and non-MGH group （ n =4192 ） .The clinical data , MGH events and mortality in 1 year of follow-up were compared between the 2 groups.Results The incidence of MGH was 1.11% （47/4239） in the subjects.The proportion of the patients with preoperative administration of warfarin and low-molecular-weight heparin was significantly higher in the MGH group than in the non-MGH group （P〈0.05）.Multivariate logistic regression analysis revealed that advanced age （〉75 years, OR=1.25, P=0.031）, anemia （OR=1.18, P=0.037）, history of gastrointestinal hemorrhage （OR=1.49, P=0.005） and chronic renal insufficiency （OR=2.27, P=0.001） were independent predictors for MGH in the patients undergoing elective PCI .In 1 year’s follow-up, the mortality was obviously higher in the MGH group than in the non-MGH group （6.4%vs 3.2%, P〈0.001）. Conclusion Clinicians should adjust the type and dosage of antiplatelet drugs based on the patient ’ s age, body mass and renal function, and correct anemia and protect renal function to decrease the occurrence of MGH .