阿司匹林致老年人早期胃黏膜损伤相关因素研究

A study of factors related to aspirin-induced early phase gastric mucosal injury in elderly people

目的观察合并服用血管紧张素受体阻滞剂(ARB)、血管紧张素转化酶抑制剂(ACEI)或他汀类药物的老年人因长期应用阿司匹林致早期胃黏膜损伤的临床和相关因素。方法回顾性分析,选取2013—2018年解放军总医院长期应用100 mg阿司匹林且合并服用ACEI/ARB或他汀类药物的老年人467例,按照胃镜结果分为胃黏膜正常组125例,慢性胃炎组199例和胃黏膜糜烂组143例。对患者的临床特征和影响ACEI/ARB和他汀类药物吸收的SLCO1B1基因多态性进行分析。结果与胃黏膜正常组比较,肾小球滤过率下降[(66.5±24.4)ml·min·1.73 m^-2比(70.9±18.5)ml·min·1.73 m^-2,OR=5.06,95%CI:2.14~11.51,P<0.01]是慢性胃炎组和胃黏膜糜烂组患者慢性胃炎危险因素;年龄[(78.5±10.1)岁比(71.5±9.6)岁,OR=1.33,95%CI:1.04~2.87,P<0.05]、胃/十二指肠溃疡史[14.0%(20/143)比5.6%(7/125),OR=2.41,95%CI:1.08~5.01,P<0.05]、未应用质子泵抑制剂[18.2%(26/143)比50.4%(63/125),OR=0.18,95%CI:0.11~0.31,P<0.01]、肾小球滤过率下降[(55.8±23.1)ml·min·1.73 m^-2比(70.9±18.5)ml·min·1.73m^-2,OR=8.04,95%CI:3.02~22.6,P<0.01]和SLCO1B1*1b二倍体[42.0%(60/143)比24.0%(30/125),OR=2.64,95%CI:1.59~4.17,P<0.05]是胃黏膜糜烂危险因素。结论SLCO1B1*1b二倍体可能通过减弱ACEI/ARB类和他汀类药物的胃黏膜保护作用增加阿司匹林致胃黏膜糜烂的风险。年龄、胃/十二指肠溃疡史、未应用质子泵抑制剂和肾功能下降也是胃黏膜损伤的危险因素。

Objective To study clinical and genetic factors for early phase gastric mucosal injury due to long-term aspirin use in elderly people treated with angiotensin-converting enzyme inhibitors(AVCEI)/angiotensin II AT-1 receptor blockers(ARB)or statins.Methods Four hundred and sixty-seven elderly persons taking 100 mg aspirin per day for a long time combined with ACEI/ARB or statins in our hospital were enrolled and retrospectively analyzed.According to endoscopy results,patients were divided into the normal gastric mucosa group(n=125),chronic gastritis group(n=199)and gastric mucosal erosion group(n=143).Clinical features and SLCO1B1 genetic polymorphisms affecting the absorption of ACEI/ARB and statins were statistically analyzed.Results Compared with the normal gastric mucosa group,reduced glomerular filtration rate(GFR)was a risk factor for chronic gastritis and gastric mucosal erosion[(66.5±24.4)ml·min·1.73 m^-2vs.(70.9±18.5)ml·min·1.73 m^-2,OR=5.06,95%CI:2.14-11.51,P<0.01].Advanced age[(78.5±10.1)years old vs.(71.5±9.6)years old,OR=1.33,95%CI:1.04-2.87,P<0.05],history of peptic ulcer[14.0%or 20/143 vs.5.6%or 7/125,OR=2.41,95%CI:1.08-5.01,P<0.05],no prescription of proton pump inhibitor[18.2%or 26/143 vs.50.4%or 63/125,OR=0.18,95%CI:0.11-0.31,P<0.01],lower GFR[(55.8±23.1)ml·min·1.73 m^-2vs.(70.9±18.5)ml·min·1.73 m^-2,OR=8.04,95%CI:3.02-22.6,P<0.01]and SLCO1B1*1b diplotype[42.0%or 60/143 vs.24.0%or 30/125,OR=2.64,95%CI:1.59-4.17,P<0.05]were risk factors for gastric mucosal erosion.Conclusions The SLCO1B1*1b diplotype may increase the risk of gastric mucosal erosion induced by aspirin via weakening the protective effects of ACEI/ARB and statins on the gastric mucosa.Advanced age,a history of peptic ulcer,no prescription of proton pump inhibitors and renal function decline are risk factors for gastric mucosal injury.