PCI术后病人消化道出血危险因素的Meta分析

Risk factors for gastrointestinal bleeding in patients after PCI:a Meta-analysis

目的:系统评价经皮冠状动脉介入治疗(PCI)术后病人发生消化道出血的危险因素。方法:系统检索中国知网(CNKI)、万方数据库、维普数据库、中国生物医学文献数据库(CBM)、the Cochrane Library、PubMed、EMbase、OVID、EBDCO host、Web of Science等公开发表的与PCI术后病人发生消化道出血危险因素相关的病例对照研究和队列研究,检索时限为建库至2023年4月,经文献筛选、数据提取、质量评价后,采用RevMan 5.2进行Meta分析。结果:共纳入16篇文献,涉及584903例病人,确定了10个危险因素、1个保护因素。Meta分析结果显示,PCI术后病人消化道出血的危险因素包括年龄≥60岁[OR=1.27,95%CI(1.20,1.34),P<0.00001]、吸烟史[OR=1.33,95%CI(1.22,1.44),P<0.00001]、高血压史[OR=1.28,95%CI(1.18,1.40),P<0.00001]、肾功能不全[OR=2.33,95%CI(1.61,3.36),P<0.00001]、既往消化道疾病史[OR=2.01,95%CI(1.47,2.75),P<0.00001]、心源性休克[OR=2.00,95%CI(1.53,2.60),P<0.00001]、诊断为急性冠脉综合征[OR=2.90,95%CI(2.07,4.07),P<0.00001]、血小板下降[OR=2.97,95%CI(1.89,4.68),P<0.00001]、基线血红蛋白下降[OR=1.55,95%CI(1.23,1.94),P=0.0002]、使用糖蛋白Ⅱb/Ⅲa抑制剂[OR=1.80,95%CI(1.40,2.30),P<0.00001];PCI术后病人消化道出血的保护因素包括使用质子泵抑制药(PPI)[OR=0.37,95%CI(0.24,0.56),P<0.00001]。结论:现有证据表明,多个因素与PCI术后病人消化道出血风险增加相关;本研究有助于临床工作人员在工作中尽早识别高危人群,采取干预措施预防消化道出血的发生和进展。

Objective:To systematically evaluate the risk factors for gastrointestinal bleeding after percutaneous coronary intervention(PCI).Methods:Publicly published case-control studies and cohort studies related to risk factors for gastrointestinal bleeding in patients after PCI were retrieved from CNKI,WanFang Database,VIP,CBM,the Cochrane Library,PubMed,EMbase,Ovid,EBDCO host,Web of Science,and other databases.The search period was up to April 2023.After literature screening,data extraction and quality evaluation,RevMan 5.2 was used for Meta-analysis.Results:A total of 16 articles were included in this study,involving 584,903 patients,and 10 risk factors and 1 protective factor were identified.Meta-analysis results showed that the risk factors for gastrointestinal bleeding in patients after PCI included age≥60 years(OR=1.27,95%CI 1.20-1.34,P<0.00001),smoking history(OR=1.33,95%CI 1.22-1.44,P<0.00001),hypertension history(OR=1.28,95%CI 1.18-1.40,P<0.00001),renal insufficiency(OR=2.33,95%CI 1.61-3.36,P<0.00001),previous history of gastrointestinal disease(OR=2.01,95%CI 1.47-2.75,P<0.00001),cardiogenic shock(OR=2.00,95%CI 1.53-2.60,P<0.00001),diagnosis of acute coronary syndrome(OR=2.90,95%CI 2.07-4.07,P<0.00001),thrombocytopenia(OR=2.97,95%CI 1.89-4.68,P<0.00001),baseline hemoglobin decline(OR=1.55,95%CI 1.23-1.94,P=0.0002),and use of glycoproteinⅡb/Ⅲa inhibitors(OR=1.80,95%CI 1.40-2.30,P<0.00001).Protective factors for gastrointestinal bleeding in patients after PCI include the use of proton pump inhibitors(PPI)(OR=0.37,95%CI 0.24-0.56,P<0.00001).Conclusion:Available evidence suggests that multiple factors are associated with an increased risk of gastrointestinal bleeding after PCI.This study is helpful for clinical staff to identify high-risk groups as early as possible and take intervention measures to prevent the occurrence and progression of gastrointestinal bleeding.