消化道出血合并心肌损伤的危险因素分析

Risk factor analysis for myocardial injury and prognosis related to gastrointestinal bleeding

目的消化道出血(gastrointestinal bleeding, GIB)可能会诱发患者发生心肌损伤,从而导致患者的死亡风险增加。本研究旨在探究GIB患者发生心肌损伤的相关危险因素,以期提高临床医生的认识、改善GIB患者的预后。方法回顾性收集中国医学科学院北京协和医院急诊科抢救室2014年1月1日至2015年12月31日收治的GIB患者。根据心肌损伤标准,将GIB患者分为合并心肌损伤组和非心肌损伤组。分别对不同组别患者的人口学资料、临床特征、实验室资料、治疗转归等资料进行单因素及Logistic 回归分析,探究GIB患者发生心肌损伤可能的相关危险因素。结果本研究共纳入219例GIB患者,其中160例患者未合并心肌损伤(非心肌损伤组),59例患者合并心肌损伤(心肌损伤组)。年龄>65岁、冠心病、心力衰竭、失血性休克、肌酐、白蛋白降低、乳酸升高是GIB合并心肌损伤的危险因素。多因素Logistic回归分析显示,年龄>65岁(OR=2.141,95%CI1.060~4.324,P=0.034)、合并心力衰竭(OR=6.928,95%CI1.469~32.671,P=0.014)、并发失血性休克(OR=2.156,95%CI1.026~4.531,P=0.043)、白蛋白降低(OR=0.939,95%CI0.886~0.995,P=0.032)可能为GIB合并心肌损伤的独立危险因素。结论在GIB患者中,合并心肌损伤者更常见于高龄患者,且其合并心力衰竭、失血性休克、低蛋白血症的风险更高。

Objective Myocardial injury may be induced in the patients with gastrointestinal bleeding (GIB).The occurrence of myocardial injury increases the risk of death.This study aims to investigate the risk factors of myocardial injury and the risk factors related to prognosis in the patients with GIB,in order to improve the understanding of clinicians and improve the prognosis of patients with GIB.Methods Patients with GIB admitted from January 1 ,2014 to December 31 ,2015 were analyzed retrospectively in the emergency department of a tertiary hospital.According to the diagnosis of myocardial injury,the patients were divided into myocardial injury group and non-myocardial injury group.Demographic data,clinical characteristics,laboratory data,treatment outcomes,and other data of patients in different groups were first analyzed by univariate analysis,and then Logistic regression analysis was used to investigate possible risk factors for myocardial injury and risk factors related to prognosis in patients with GIB.Results Of 219 patients with GIB,160 patients had no myocardial injury and 59 patients had myocardial injury.Among them,age >65 years,coronary heart disease,heart failure,hemorrhagic shock,creatinine,albumin,lactic acid were risk factors for myocardial injury with GIB.Multivariate Logistic regression analysis found that age > 65 years (OR=2.141,95% CI 1.060-4.324,P =0.034),combined heart failure (OR=6.928 ,95% CI 1.469-32.671 ,P =0.014),hemorrhagic shock (OR =2.156,95% CI 1.026-4.531 ,P=0.043),and reduced albumin (OR=0.939,95% CI 0.886-0.995 ,P=0.032) may be an independent risk factor for GIB complicated with myocardial injury.Conclusion GIB patients complicated with myocardial injury are more common in older age and are at higher risk of heart failure,hemorrhagic shock,and hypoalbuminemia.