幽门螺杆菌感染与冠心病患者抗血小板治疗后上消化道出血的关系研究

Relationships between Helicobacter Pylori Infection and Upper Gastrointestinal Bleeding after Antiplatelet Therapy in Patients with Coronary Heart Disease

目的探究幽门螺杆菌(Hp)感染与冠心病(CHD)患者抗血小板治疗后上消化道出血的关系。方法选取在2015年8月-2016年8月期间来我院治疗的冠心病患者132例作为研究对象。根据患者是否感染Hp将患者分为Hp阳性组和Hp阴性组。其中Hp阳性组100例,Hp阴性组32例,所有患者均进行抗血小板治疗。采用随机数字表法,将Hp阳性组患者100例分成对照组和观察组,每组均为50例。所有患者皆采取常规阿司匹林和氯吡格雷抗血小板治疗,其中观察组实施幽门螺杆菌根除治疗,并且在治疗1个月后观察治疗效果。所有患者在治疗后1年时进行随访,同时记录各组上消化道出血和贫血情况,检测患者的血肌酐、谷丙转氨酶、血浆凝血酶原时间、血红蛋白含量。结果在Hp阳性、Hp阴性指标上,观察组(4%、96%)显著优于对照组(100%、0),差异有统计学意义(χ2=88.679,χ2=92.308,P<0.05);观察组上消化道出血发生率与对照组差异无统计学意义(χ2=1.042,P>0.05);在治疗后的1年随访中,Hp阳性观察组发生1例(2%)上消化道出血,Hp阳性对照组发生7例(14%)上消化道出血,Hp阴性组未出现消化道出血,且三组患者在该指标上差异具有统计学意义(χ2=9.048,P<0.05);在黑便、呕血及粪便隐血阳性等临床表现指标上,三组患者差异无统计学意义(P>0.05);在贫血、血肌酐、谷丙转氨酶、血浆凝血酶原时间、血红蛋白含量指标上,三组患者差异具有统计学意义(P<0.05);且在血红蛋白、血浆凝血酶原时间及血肌酐指标上,Hp阳性观察组均显著高于Hp阳性对照组,差异具有统计学意义(P<0.05)。结论幽门螺杆菌感染会增加冠心病抗血小板治疗时出现上消化道出血的概率,幽门螺杆菌根除治疗则可以降低发生上消化道出血的风险。

Objective To investigate the correlations between Helicobacter pylori（ Hp） infection and upper gastrointestinal bleeding after antiplatelet therapy in patients with coronary heart disease（ CHD）. Methods A total of 132 cases of patients treated in our hospital between August 2015 and August 2016 were selected as subjects. These patients were divided into the Hp-positive group and Hp-negative group according to infections with H. pylori. One hundred patients in the Hp positive group and32 patients in the Hp negative group received antiplatelet therapy. Using a random number table method,the 100 Hp positive patients were randomly divided into the control group and the observation group,with 50 cases in each. All these patients were treated with conventional aspirin and clopidogrel antiplatelet therapy. The observation group was treated with H. pylori eradication and the therapeutic effect was observed after 1 month of treatment. All the patients were followed up for 1 year. Upper gastrointestinal bleeding and anemia were recorded in each group. Serum creatinine,alanine aminotransferase,plasma prothrombin time,and hemoglobin were measured. Results With regard to Hp-positive and Hp-negative indicators,the observation group（ 6%,96%）was significantly better than the control group（ 100%,0）,and the difference was statistically significant（ χ2= 88. 679,χ2 = 92.308,P〈0.05）.There was no significant difference in the incidence of upper gastrointestinal bleeding between the observation group and the control group（ χ2= 1.042,P〈0.05）. During the one-year follow-up,there was one case of upper gastrointestinal bleeding in the Hp-positive observation group（ 2%）,7 cases（ 14%） in the Hp-positive control group,but none in the Hp-negative group. The difference between the three groups was statistically significant（ χ2= 9.048,P〈0.05）. As for such clinical performance indicators as melena,vomiting blood and fecal occult blood positiveness,there was no significant difference between the three groups（ P〈0.05）. Anemia,serum creatinine,alanine aminotransferase,plasma prothrombin time and hemoglobin content were significantly different between the three groups（ P〈0.05）. The Hp-positive observation group was significantly higher than Hp-positive control group in terms of hemoglobin,prothrombin time and serum creatinine.Conclusion Chances of Helicobacter pylori infection increase with upper gastrointestinal bleeding during antiplatelet therapy in coronary heart disease,but H.pylori eradication can reduce the risk of upper gastrointestinal bleeding.