抗血小板药物治疗冠心病病人中应用CRUSADE评分对消化系统出血风险的评估作用

Assessment of risk of gastrointestinal bleeding using CRUSADE score in patients with coronary heart disease treated with antiplatelet therapy

目的:分析抗血小板药物治疗冠心病病人中应用CRUSADE评分对消化道出血风险的评估作用。方法:选取服用抗血小板药物>1年的冠心病病人145例,按照有无发生消化道出血分为消化系统出血组(45例)和无消化系统出血组(100例),比较2组病人临床特征,采用CRUSADE评分评估2组病人消化系统出血的风险。结果:消化系统出血组病人年龄明显大于无消化系统出血组(P<0.01);消化系统出血组病人具有消化系统溃疡、出血史率明显高于无消化系统出血组(P<0.01);2组病人性别、吸烟史、幽门螺杆菌感染史、肝肾功能异常史、口服硫酸氢氯吡格雷片、阿司匹林肠溶片及两药合用率差异均无统计学意义(P>0.05)。CRUSADE评分结果显示,消化系统出血组病人危险度明显高于无消化系统出血组(P<0.01)。结论:抗血小板药物治疗冠心病病人中应用CRUSADE评分有利于评估消化系统出血的风险,对CRUSADE评分为消化系统出血高危和极高危者可采用质子泵抑制剂以降低长期服用抗血小板药物引起的消化系统出血的风险。

Objective:To analyze the role of CRUSADE score in assessing the risk of gastrointestinal bleeding in patients with coronary heart disease treated with antiplatelet therapy.Methods:A total of 145 patients with coronary heart disease treated with antiplatelet drug for more than one year were selected and divided into gastrointestinal bleeding group(n=45)and non-gastrointestinal bleeding group(n=100)according to whether the patients had gastrointestinal bleeding or not.The clinical characteristics were compared,and the risk of gastrointestinal bleeding in two groups was evaluated by CRUSADE score.Results:The age of the patients in gastrointestinal bleeding group was significantly higher than that in non-gastrointestinal bleeding group(P<0.01).The proportion of peptic ulcer and bleeding history in patients in gastrointestinal bleeding group was significantly higher that in non-gastrointestinal bleeding group(P<0.01).There was no significant difference in gender,smoking history,Helicobacter pylori infection history,abnormal history of liver and kidney function,oral clopidogrel bisulfate tablet,aspirin enteric-coated tablet and the combination rate of the two drugs in two groups(P>0.05).The result of CRUSADE score showed that the risk degree of patients in gastrointestinal bleeding group was significantly higher than that in non-gastrointestinal bleeding group(P<0.01).Conclusions:The use of CRUSADE score in patients with coronary heart disease treated with antiplatelet therapy is beneficial to assess the risk of gastrointestinal bleeding.For patients with CRUSADE score of high risk and very high risk of gastrointestinal bleeding,proton pump inhibitor can be used to reduce the risk of gastrointestinal bleeding caused by long-term use of antiplatelet drug.