老年人非甾体抗炎药相关性上消化道出血的临床特点

Clinical characteristics of NSAIDs-related upper gastrointestinal bleeding in the elderly

目的总结老年人非甾体抗炎药(NSAIDs)相关性上消化道出血(UGIB)的临床特点。方法收集2013年1月至2018年12月期间218例NSAIDs相关性UGIB患者的临床资料,按照年龄分为老年组(≥65岁)和非老年组(<65岁)。回顾性分析2组患者在诱发出血的药物、预防性胃黏膜保护用药情况、首发症状、内镜表现、再出血率和死亡率等方面的特点。结果2组患者均以阿司匹林为常用的NSAIDs,老年组联合用药比例高于非老年组(18.1%vs 4.3%,P<0.01);经评估,老年组需要使用胃黏膜保护药物的比例明显高于非老年组(42%vs 22.2%,P<0.01);实际使用胃黏膜保护药物的患者比例,老年组与非老年组均较低(3.8%vs 7.4%,P>0.05);2组患者均以黑粪为常见的首发症状,且多表现为无痛性出血,内镜检查均以消化性溃疡多见,但老年组以胃溃疡多见;老年组出血时停用NSAIDs的比例低于非老年组(83.9%vs 94.2%,P<0.05);老年组再出血率低于非老年组(4.1%vs 14.5%,P<0.05)。结论老年人NSAIDs相关性UGIB以黑粪为首发症状,常表现为消化性溃疡,再出血率较低。应加强患者教育,降低胃肠道黏膜损伤风险。

AIM To study the clinical characteristics of upper gastrointestinal bleeding(UGIB)associated with non-steroidal anti-inflammatory drugs(NSAIDs)in the elderly.METHODS The 218 patients with NSAIDsassociated UGIB from January 2013 to December 2018 were divided into the elderly group(≥65 years old)and the non-elderly group(<65 years old)according to their age.The data of 2 groups was retrospective analyzed,including the types of medication,preventive medication for gastric mucosa protection,first symptoms,endoscopic manifestations,rebleeding rate,mortality and other aspects of the characteristics.RESULTS The proportion of NSAIDs commonly used in both groups was aspirin,and the proportion of combined drugs in the elderly group was higher than that in the non-elderly group(18.1%vs 4.3%,P<0.01).The proportion of gastric mucosal protective drugs needed in the elderly group was significantly higher than that in the non-elderly group(42%vs 22.2%,P<0.01).The actual use of protective drugs for gastric mucosa was low in both the elderly group and the non-elderly group(3.8%vs 7.4%,P>0.05).Black stool was the common first symptom in both groups,and most of them showed painless bleeding.Peptic ulcer was more common in both groups,but gastric ulcer was more common in the elderly group.The proportion of discontinuation of NSAIDs in the elderly group was lower than that in the non-elderly group(83.9%vs 94.2%,P<0.05).The rate of rebleeding in the elderly group was lower than that in the non-elderly group(4.1%vs 14.5%,P<0.05).CONCLUSION Aspirin is the most commonly used NSAIDs in elderly patients with NSAIDS-associated UGIB,and the proportion of multiple drugs is high,but the utilization rate of gastric mucosal protective drugs is low;the elderly often take black stool as the first symptom,and the abdominal symptoms are more atypical;endoscopic examination is often manifested as peptic ulcer,and gastric ulcer is more common;the rate of rebleeding in the elderly group is lower than that in the non-elderly group.