双联抗血小板药物对心脑血管疾病患者上消化道出血风险的影响许三雄,程蕾群

Influence of dual antiplatelet drugs on risk of upper gastrointestinal hemorrhage in patients with cardio-and cerebrovascular diseases

目的:探讨双联抗血小板药物对心脑血管疾病患者上消化道出血风险的影响。方法:回顾性分析963例患心脑血管疾病,且服用双联抗血小板药物患者的资料,以是否出现上消化道出血为因变量,以年龄、性别、吸烟史、饮酒史、消化道出血或溃疡史、幽门螺杆菌(HP)感染、联用质子泵抑制剂(PPI)等临床因素作为自变量,比较不同临床因素下的上消化道出血情况,采用Logistic多元回归分析服用双联抗血小板药物治疗心脑血管疾病患者出现上消化道出血的独立危险因素。结果:963例服用双联抗血小板药物治疗的心脑血管疾病患者中有68例(7.06%)发生上消化道出血,单因素分析显示老年(≥65岁)、有吸烟史、饮酒史、消化道出血或溃疡史、HP感染及不联用PPI患者的上消化道出血发生率显著较高(P均=0.001);经Logistic多元回归分析,老年(≥65岁)、吸烟、有消化道出血或溃疡史、HP感染是上消化道出血的独立危险因素(OR=1.860~5.730,P<0.05或<0.01),而联用PPI是上消化道出血的独立保护因素(OR=0.116,P=0.001)。结论:对老年、吸烟、具有消化道出血或溃疡史,且感染HP的心脑血管病患者,应警惕上消化道出血,及早联用PPI,以减小上消化道出血风险。

Objective:To explore influence of dual antiplatelet drugs on risk of upper gastrointestinal hemorrhage(UGIH)in patients with cardio-and cerebrovascular diseases(CCVD).Methods:Clinical data of 963 CCVD patients,who received dual antiplatelet medication,were retrospectively analyzed.With presence of UGIH as dependent variable,clinical factors including age,gender,history of smoking,drinking,gastrointestinal hemorrhage or ulcer,Helicobacter pylori(HP)infection,combined use of proton pump inhibitor(PPI)etc.as independent variables;upper gastrointestinal hemorrhage condition under different clinical factors were compared.Logistic multi-factor regression analysis was used to analyze independent risk factors of UGIH treated by dual antiplatelet drugs in CCVD patients.Results:UGIH occurred in 68 cases(7.06%)among the 963 patients.Single factor analysis indicated that old age(≥65 years old),history of smoking,drinking,gastrointestinal hemorrhage or ulcer,HP infection and no combined use of PPI lead to a significant higher incidence rate of UGIH,P=0.001 all;Logistic multi-factor regression analysis indicated that old age(≥65 years old),smoking,gastrointestinal hemorrhage or ulcer history and HP infection were independent risk factors for UGIH(OR=1.860~5.730,P<0.05 or<0.01),while combined used of PPI was its independent protective factor(OR=0.116,P=0.001).Conclusion:For CCVD patients with old age,history of smoking,gastrointestinal hemorrhage or ulcer and HP infection,it is necessary to be cautious for incidence of UGIH and receive combined use of PPI early,which may help to reduce risk of UGIH.