磁控胶囊内镜对服用肠溶阿司匹林老年患者上消化道出血风险评估的价值探讨

Magnetically controlled capsule endoscopy for preliminary risk assessment of upper gastrointestinal bleeding in elderly patients taking enteric-coated aspirin

目的探讨磁控胶囊内镜对评估服用肠溶阿司匹林的老年患者上消化道出血风险的价值。方法分析2018年1月—2020年12月在首都医科大学附属北京朝阳医院和北京安贞医院行磁控胶囊内镜检查的服用肠溶阿司匹林的老年患者临床资料,评估其上消化道出血的风险,进行评分和分组(评分≤3分者为低危组,评分>3分者为中高危组)。比较低危组和中高危组患者间上消化道出血发生率、胃和十二指肠黏膜损伤的差别。结果入选的66例患者男45例、女21例,年龄60~81岁,均服用肠溶阿司匹林,其中出血者17例。低危组(n=51)和中高危组(n=15)患者,上消化道出血发病率分别为17.6%和53.3%(P<0.001),胃溃疡发病率分别为5.9%和26.7%(P<0.001),胃黏膜损伤评分中位数分别为2.0和2.0(P=0.621),十二指肠溃疡发病率分别为2.0%和18.8%(P<0.001),十二指肠损伤评分中位数分别为1.0和1.0(P=0.936)。磁控胶囊内镜对该类患者预测上消化道出血风险的受试者工作特征曲线下面积为0.855。结论服用肠溶阿司匹林的老年患者上消化道出血风险评估可用于预测患者上消化道出血风险,但评分细则尚需进一步完善。中高危患者可使用磁控胶囊内镜监测阿司匹林相关上消化道黏膜损伤。

Objective To investigate the clinical application value of magnetically controlled capsule endoscopy(MCCE)for risk assessment of upper gastrointestinal bleeding in elderly patients taking enteric-coated aspirin.Methods Clinical data of elderly patients taking enteric-coated aspirin and undergoing MCCE from January 2018 to December 2020 in Beijing Chaoyang and Beijing Anzhen Hospital,Capital Medical University were analyzed.Patients were divided into low-risk group(scores^3)and moderate/high risk group(scores>3)to study the risk assessment of upper gastrointestinal bleeding in elderly patients taking enteric-coated aspirin.Results A total of 66 patients(aged 60-81 years,45 males and 21 females)were enrolled and 17 patients developed bleeding.The indicators of low-risk(n=51)and moderate/high risk groups(n=15)were as follows:the incidences of upper gastrointestinal bleeding were 17.6%and 53.3%(P<0.001),gastric ulcer 5.9%and 26.7%(P<0.001),median gastric Lanza score 2.0 and 2.0(P=0.621),duodenal ulcer 2.0%and 18.8%(P<0.001),median duodenal mucosal injury score 1.0 and 1.0(P=0.936), respectively.Receiver operator characteristic curve showed that the area under the curve of risk assessment of upper gastrointestinal bleeding in elderly patients taking enteric-coated aspirin by MCCE was 0.855.Conclusion Risk assessment of upper gastrointestinal bleeding in elderly patients taking enteric-coated aspirin can be used to predict the risk of upper gastrointestinal bleeding,hut the scoring rules need to be further improved.Moderate and high-risk patients should undergo MCCE to monitor aspirin related upper gastrointestinal mucosal injury.