服用阿司匹林患者发生严重小肠黏膜损伤与乳果糖氢呼气试验的关系初探

The relationship between severe intestinal mucosal injury and lactulose hydrogen breath test in patients taking Aspirin

目的初步探索服用阿司匹林患者发生严重小肠黏膜损伤与乳果糖氢呼气试验(lactulose hydrogen breath test,LHBT)阳性的关系。方法收集2019年5月至2019年12月在首都医科大学附属北京安贞医院就诊的服用肠溶阿司匹林治疗1个月以上的患者106例,均行磁控胶囊内镜和LHBT,收集患者临床资料,定义严重小肠损伤为磁控胶囊内镜发现小肠内有4处以上小糜烂或有大糜烂、溃疡,比较发生严重小肠损伤与未发生严重小肠损伤患者的临床资料,将差异有统计学意义的指标纳入Logistic回归模型,评价服用阿司匹林且LHBT阳性患者发生小肠严重损伤的风险,再将所有患者根据LHBT结果分为阳性组和阴性组,比较两组的小肠黏膜损伤程度及严重小肠损伤的发生情况。结果106例患者中,18例(17.0%)存在严重小肠黏膜损伤,其中LHBT阳性者8例(44.4%),非严重小肠黏膜损伤的88例患者中LHBT阳性者18例(20.5%)。两组比较,年龄、胃肠道症状评分、胃黏膜损伤评分、LHBT阳性率差异有统计学意义(P=0.035,P=0.037,P=0.006,P=0.031)。二元Logistic回归分析显示,LHBT阳性者发生小肠严重损伤的风险增加(比值比:5.915,95%CI:1.525~22.945,P=0.010)。LHBT阳性组和阴性组比较,小肠损伤程度及小肠严重损伤发生率比较,差异均有统计学意义(P=0.009,P=0.031)。结论服用阿司匹林患者发生严重小肠损伤与LHBT阳性有关,LHBT阳性者小肠损伤程度重,发生严重小肠损伤的比例高。

Objective To explore the relationship between severe intestinal mucosal injury and lactulose hydrogen breath test(LHBT)in patients taking Aspirin.Methods 106 patients taking Aspirin for over one month in Beijing Anzhen Hospital,Capital Medical University from May 2019 to Dec.2019 were enrolled.They were examined by magnetically controlled capsule endoscopy and LHBT,clinical data were collected.We defined severe small bowel injury as the presence of more than 4 small erosions or large erosions/ulcers by magnetic capsule endoscopy.The clinical data of patients with or without severe small bowel injury were compared,and the indicators with statistical differences were included in the Logistic regression model to evaluate the risk of severe intestinal injury in LHBT positive result patients taking Aspirin.Then all patients were divided into the LHBT positive group and the LHBT negative group according to the results of LHBT.The degree of intestinal mucosal injury and the occurrence of severe intestinal injury were compared between the two groups.Results Out of 106 patients,18 patients(17.0%)had severe small intestinal injury.The LHBT was positive in 8 patients(44.4%)with severe small intestinal injury and in 18 patients(20.5%)without severe small intestinal injury.There were significant differences in age,gastrointestinal symptom score,gastric mucosal injury score and LHBT positive results between the two groups(P=0.035,P=0.037,P=0.006,P=0.031).Logistic regression analysis showed that the patients of LHBT positive results had an increased risk of severe intestinal injury(odds ratio:5.915,95%CI:1.525-22.945,P=0.010).There were significant differences in the degree of small intestinal injury and the incidence of severe small intestinal injury between LHBT positive group and LHBT negative group(P=0.009,P=0.031).Conclusion The positive results of LHBT is associated with severe intestinal injury in patients taking Aspirin.The degree of small intestinal injury was serious in LHBT positive patients,and the proportion of severe small intestinal injury is high.