质子泵抑制剂及粪便隐血试验对心内科住院老年患者新发消化道出血的预测价值

Predictive values of PPI and fecal occult blood test in new-onset GIB in elderly patients admitted to cardiological department

目的 探讨质子泵抑制剂(PPI)及粪便隐血试验在心内科住院老年患者新发消化道出血(GIB)的预防及预测价值。方法 回顾性分析2014年1月至2018年12月于北京电力医院心内科住院的老年患者3744例临床资料,根据是否使用PPI分为PPI组976例和非PPI组2768例。采用ROC曲线下面积判断粪便隐血试验对新发GIB的预测价值。结果 PPI组阿司匹林+氯吡格雷使用率明显高于非PPI组(P<0.01)。在调整应用阿司匹林+氯吡格雷因素后,PPI与GIB及死亡无关(P>0.05)。在调整年龄、血红蛋白及阿司匹林等后,粪便隐血试验阳性与GIB发生率增加相关(P<0.01)。入院时粪便隐血试验预测发生GIB的ROC曲线下面积为0.865。粪便隐血试验阳性是发生GIB的独立危险因素(OR=35.645,95%CI:11.374~63.395,P<0.01),而PPI对GIB的发生没有影响(OR=0.786,95%CI:0.118~0.923,P=0.624)。结论 PPI可能不会降低心内科住院老年患者住院期间新发GIB的发生率及病死率,另外粪便隐血试验似乎对排除GIB的意义更大。

Objective To explore the preventive and predictive values of PPI and fecal occult blood test in new-onset GIB in the elderly patients admitted to cardiologcal department.Methods Clinical data of 3744 elderly patients hospitalized in Department of Cardiology of Beijing Electric Power Hospital from January 2014 to December 2018 were collected and retrospectively analyzed.According to the use of PPI,they were divided into PPI group(n=976) and non-PPI group(n=2768).The area under ROC curve was used to assess the predictive value of fecal occult blood test in new-onset GIB.Results The utilization rate of aspirin and clopidogrel was significantly higher in the PPI group than the non-PPI group(P<0.01).After adjustment of the confounding factors of aspirin+clopidogrel, no correlation was observed in PPI with GIB and death(P>0.05).After adjustment of age, hemoglobin and aspirin, the positive rate of fecal occult blood test was identified to be related to the increased GIB incidence(P<0.01).The area under the ROC curve of fecal occult blood test at admission to predict the occurrence of GIB was 0.865.The positive result of fecal occult blood test was an independent risk factor for the occurrence of GIB(OR=35.645,95%CI:11.374-63.395,P<0.01),while PPI had no effect on the occurrence(OR=0.786,95%CI:0.118-0.923,P=0.624).Conclusion PPI may have no effect on the incidence of new-onset GIB or mortality in elderly patients in cardiological department, and fecal occult blood test seems to be of more significance in excluding GIB.