冠心病双联抗血小板治疗中消化道出血的相关危险因素分析

Risk factors of gastrointestinal hemorrhage in patients with coronary heart disease treated with dual antiplatelet therapy

目的探讨冠心病双联抗血小板治疗中消化道出血的相关危险因素。方法选取北京大学国际医院2015年1月至2017年1月收治疗的冠心病患者200例为研究对象,采用随机数字表法分为两组,对照组100例采用阿司匹林治疗,治疗组100例采用阿司匹林联合氯吡格雷治疗,两组均治疗12个月,随访6个月。观察两组患者消化道出血发生率,分析双联抗血小板治疗过程出现消化道出血患者的性别、年龄、肾功能减退、幽门螺杆菌(Hp)感染、负荷剂量、全球急性冠脉事件登记(GRACE)评分高危、用药时间、联合口服质子泵抑制剂(PPI)、胃肠病史等资料,探讨冠心病双联抗血小板治疗中消化道出血的相关危险因素。结果治疗组消化道出血发生率为39.0%(39/100),明显高于对照组的1.0%(1/100),差异有统计学意义(χ^2=12.365,P<0.01);出血患者的年龄(>70岁)(30.0%)、肾功能减退(30.0%)、用药时间超过3个月(29.0%)、Hp感染(29.0%)、负荷剂量(28.0%)、联合口服PPI(26.0%)、胃肠病史(31.0%)所占比例明显高于未出血患者,差异均有统计学意义(χ^2=6.326、6.326、5.689、6.124、6.054、5.365、6.985,均P<0.05);而出血患者与未出血患者性别、GRACE评分高危差异均无统计学意义(均P>0.05);多因素logistic回归分析显示,年龄、肾功能减退、Hp感染、负荷剂量、用药时间超过3个月、联合口服PPI、胃肠病史是冠心病双联抗血小板治疗中消化道出血的危险因素(r=9.646、7.435、6.435、11.769、3.052、4.199、8.511,均P<0.05)。结论冠心病患者进行双联抗血小板治疗容易出现消化道出血,而且年龄>70岁、患有肾功能不全、用负荷剂量、Hp感染等会增加消化道出血的危险。

Objective To study the risk factors of gastrointestinal hemorrhage in coronary heart disease(CHD)patients treated by dual anti-platelet therapy.Methods From January 2015 to January 2017,200 patients with CHD in International Hospital of Peking University were studied and randomly divided into two groups according to the digital table,with 100 cases in each group.The treatment group was treated with aspirin and clopidogrel,and the control group was treated with aspirin.The patients were treated for 12 months and followed up for 6 months.The incidence rate of gastrointestinal hemorrhage was observed in the two groups,and the sex,age,renal function,HP infection,high risk of global registration of acute coronary events(GRACE)score and time of medication,combined with oral proton pump inhibitor(PPI),gastrointestinal history and other data were analyzed in the patients with gastrointestinal bleeding in the course of dual antiplatelet therapy.The risk factors of gastrointestinal hemorrhage in CHD patients treated with dual anti-platelet therapy were analyzed.Results The incidence rate of gastrointestinal bleeding of the treatment group[39.0%(39/100)]was higher than that of the control group[1.0%(1/100)](χ^2=12.365,P<0.01).The age(over 70 years old)(30.0%),renal function(29.0%),Hp infection(29.0%),load dose(28.0%),combined oral PPI(26.0%)and gastrointestinal history(31.0%)in the patients with hemorrhage were significantly higher than those in the patients without bleeding(χ^2=6.326,6.326,5.689,6.124,6.054,5.365,6.985,all P<0.05).There were no statistically significant differences in sex and GRACE score between the hemorrhage patients and patients without bleeding(all P>0.05).Multivariate logistic regression analysis showed that age,renal dysfunction and HP infection,load dose,medication time more than 3 months,combined oral administration of PPI,gastrointestinal history were the risk factors of gastrointestinal bleeding in patients with CHD combined with anti-platelet therapy(r=9.646,7.435,6.435,11.769,3.052,4.199,8.511,all P<0.05).Conclusion The patients with CHD are prone to gastrointestinal bleeding after dual antiplatelet therapy,and they are over 70 years old and suffer from renal insufficiency.The risk of gastrointestinal bleeding can be increased by loading dose of HP infection.