急性缺血性脑卒中患者阿司匹林致上消化道出血情况及其影响因素研究

Incidence of Aspirin-induced Upper Gastrointestinal Hemorrhage and the Influencing Factors in Patients with Acute Ischemic Stroke

目的分析急性缺血性脑卒中(AIS)患者阿司匹林致上消化道出血情况及其影响因素。方法选取2012-01-01至2015-06-30泰州市人民医院收治的AIS患者907例,住院期间均常规给予阿司匹林治疗,出院后随访18个月,记录其出血情况,AIS患者阿司匹林致上消化道出血的影响因素分析采用多因素Logistic回归分析。结果907例患者随访过程中剔除85例,最终纳入822例患者,阿司匹林致上消化道出血发生率为6.4%(53/822);出血时间:AIS后0~3个月20例(占37.7%),AIS后4~6个月12例(占22.6%),AIS后7~9个月6例(占11.4%),AIS后10~12个月6例(占11.4%),AIS后13~15个月4例(占7.5%),AIS后16~18个月5例(占9.4%);出血原因:急性胃黏膜损伤26例(占49.1%),十二指肠溃疡17例(占32.1%),胃溃疡8例(占15.0%),食管炎1例(占1.9%),胃癌1例(占1.9%)。有无阿司匹林致上消化道出血患者男性比例、吸烟史、服药规律者所占比例及联用氯吡格雷者所占比例比较,差异无统计学意义(P>0.05);有无阿司匹林致上消化道出血患者年龄、饮酒史、幽门螺杆菌(Hp)感染发生率、既往有消化道不适症状者所占比例、有消化道出血史及联用质子泵抑制剂(PPI)者所占比例比较,差异有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,年龄[OR=2.246,95%CI(1.162,4.339)]、饮酒史[OR=1.900,95%CI(1.065,3.390)]、Hp感染[OR=9.013,95%CI(5.008,16.232)]及有消化道出血史[OR=3.196,95%CI(1.632,6.261)]是AIS患者阿司匹林致上消化道出血的危险因素(P<0.05),联用PPI是AIS患者阿司匹林致上消化道出血的保护因素[OR=0.467,95%CI(0.250,0.873),P<0.05]。结论AIS患者阿司匹林致上消化道出血发生率较高,出血主要发生在AIS后6个月内,主要出血原因为急性胃黏膜损伤和十二指肠溃疡;年龄、饮酒史、Hp感染及有消化道出血史是AIS患者阿司匹林致上消化道出血的危险因素,联用PPI是AIS患者阿司匹林致上消化道出血的保护因素。

Objective To analyze the incidence of aspirin - induced upper gastrointestinal hemorrhage and the influencing factors in patients with acute ischemic stroke. Methods A total of 907 patients with acute ischemic stroke were selected in the People1 s Hospital of Taizhou from 2012 - 01 - 01 to 2015 - 06 - 30, all of them received aspirin during hospitalization and were followed up for 18 months after discharge, incidence of aspirin - induced upper gastrointestinal hemorrhage was recorded, and influencing factors of aspirin - induced upper gastrointestinal hemorrhage in patients with acute ischemic stroke were analyzed by multivariate Logistic regression analysis. Results A total of 85 patients were rejected during the follow - up, therefore a total of 822 patients enrolled in this study at last; the incidence of aspirin - induced upper gastrointestinal hemorrhage was 6. 4% （53/822） , hemorrhage occurrence time ： 20 cases during 0 to 3 months after attack （accounting for 37. 7% ）,12 cases during 4 to 6 months after attack （ accounting for 22. 6% ） , 6 cases during 7 to 9 months after attack （ accounting for 11.4% ） , 6 cases during 10 to 12 months after attack （ accounting for 11.4%）, 4 cases during 13 to 15 months after attack （ accounting for 7. 5% ） , 5 cases during 16 to 18 months after attack （ accounting for 9. 4% ）; hemorrhage causes ： 26 cases with acute gastric mucosa injury （ accounting for 49.1 %）, 17 cases with duodenal ulcer （accounting for 32.1%）,8 cases with gastric ulcer （ accounting for 15.0%）, 1 case with oesophagitis （ accounting for 1.9%）,1 case with stomach cancer （ accounting for 1. 9% ）. No statistically significant differences of male ratio, smoking history, proportion of patients with regular medication or patients using clopidogrel in patients with or without aspirin - induced upper gastrointestinal hemorrhage （P 〉 0. 05 ） , while there statistically significant differences of age, drinking history, Hp infection, proportion of patients with previous digestive tract discomfort, patients with history of gastrointestinal bleeding and patients using proton pump inhibitor （ PPI） in patients with or without aspirin - induced upper gastrointestinal hemorrhage （P 〈0.05）. Multivariate Logistic regression analysis results showed that, age [ OR = 2. 246, 95% CI （1 .1 6 2 , 4 .3 3 9 ） ] , drinking history〔OR = 1.900,95% CI （1.065,3.390））,Hp in fection（OR= 9. 013,95% C7 （5. 008,16. 232）〕and history of gastrointestinal bleeding [ OR = 3. 196, 95% CI （1. 632,6. 261））were risk factors of aspirin - induced upper gastrointestinal hemorrhage in patients with acute ischemic stroke （ P 〈 0. 05 ） , while using PPI was the protective factor [ OR = 0. 467 , 95% CI （0.250,0.873 ）,P 〈 0. 05 ]. Conclusion Incidence of aspirin - induced upper gastrointestinal hemorrhage and the influencing factors is relatively high in patients with acute ischemic stroke, mainly occurred after 6 months of attack, acute gastric mucosa injury and duodenal ulcer are the major hemorrhage causes ; age, drinking history, Hp infection and history of gastrointestinal bleeding are risk factors of aspirin - induced upper gastrointestinal hemorrhage in patients with acute ischemic stroke, while using PPI was the protective factor.