Clinical effects of psychological intervention and drug therapy against peptic ulcer

Objective:To evaluate the clinical effects of psychological interventions and drug therapy against peptic ulcer.Methods:96 patients with peptic ulcer were divided into control group with Tagamet 800 mg per evening p.o.and trial group with psychological intervention on the basis of drug treatment.Results:There were significant differences between the two groups(P【0.05), the trial group showed that the anxiety and depression cases declined obviously and effective rate of ulcer therapy was much higlier than control group.Conclusions:In sum,psychological intervention combined with drug therapy provides an effective method for ulcer treatment.

Helicobacter pylori infection in bleeding peptic ulcer patients after non-steroidal antiinflammatory drug consumption

AIM： TO establish the prevalence of He/icobacterpy/on （H. pylori） infection in patients with a bleeding peptic ulcer after consumption of non-steroidal antiinflammatory drugs （NSAIDs）.METHODS： A very early upper endoscopy was performed to find the source of upper gastrointestinal bleeding and to take biopsy specimens for analysis of H. pylori infection by the rapid urease （CLO） test, his- tological examination, and bacterial culture. TgG anti- CagA were also sought. The gold standard for identifying H. pylori infection was positive culture of biopsy specimens or contemporary positivity of the CLO test and the presence of H. pylori on tissue sections.RESULTS： Eighty patients, 61 males （76.3%）, mean age 61.2 ~ 15.9 years, were consecutively enrolled. Forty-seven （58.8%） patients occasionally consumed NSAIDs, while 33 （41.3%） were on chronic treatment with low-dose aspirin （LD ASA）. Forty-four （55.0%） patients were considered infected by H. pylori. The infection rate was not different between patients who occasionally or chronically consumed NSAIDs. The culture of biopsy specimens had a sensitivity of 86.4% and a specificity of 100%; corresponding figures for histological analysis were 65.9% and 77.8%, for the CLO test were 68.2% and 75%, for the combined use of histology and the CLO test were 56.8% and 100%, and for IgG anti-CagA were 90% and 98%. The high- est accuracy （92.5%） was obtained with the culture of biopsy specimens.CONCLUSION： Patients with a bleeding peptic ulcer after NSAID/LD ASA consumption frequently have H. pylori infection. Biopsy specimen culture after an early upper gastrointestinal tract endoscopy seems the most efficient test to detect this infection.

Clinical characteristics of Helicobacter pylori-negative drugnegative peptic ulcer bleeding

AIM:To investigate the clinical characteristics and outcomes of idiopathic Helicobacter pylori(H.pylori)-negative and drug-negative]peptic ulcer bleeding(PUB).METHODS:A consecutive series of patients who experienced PUB between 2006 and 2012 was retrospectively analyzed.A total of 232 patients were enrolled in this study.The patients were divided into four groups according to the etiologies of PUB:idiopathic,H.pylori-associated,drug-induced and combined(H.pylori-associated and drug-induced)types.We compared the clinical characteristics and outcomes between the groups.When the silver stain or rapid urease tests were H.pylori-negative,we obtained an additional biopsy specimen by endoscopic re-examination and performed an H.pylori antibody test 6-8 wk after the initial endoscopic examination.For a diagnosis of idiopathic PUB,a negative result of an H.pylori antibody test was confirmed.In all cases,re-bleeding was confirmed by endoscopic examination.For the risk assessment,the Blatchford and the Rockall scores were calculated for all patients.RESULTS:For PUB,the frequency of H.pylori infection was 59.5%(138/232),whereas the frequency of idiopathic cases was 8.6%(20/232).When idiopathic PUB was compared to H.pylori-associated PUB,the idiopathic PUB group showed a higher rate of rebleeding after initial hemostasis during the hospital stay(30%vs 7.4%,P = 0.02).When idiopathic PUB was compared to drug-induced PUB,the patients in the idiopathic PUB group showed a higher rate of rebleeding after initial hemostasis upon admission(30%vs 2.7%,P < 0.01).When drug-induced PUB was compared to H.pylori-associated PUB,the patients in the drug-induced PUB were older(68.49 ± 14.76 years vs 47.83 ± 15.15 years,P< 0.01) and showed a higher proportion of gastric ulcer(77%vs 49%,P < 0.01).However,the Blatchford and the Rockall scores were not significantly different between the two groups.Among the patients who experienced drug-induced PUB,no significant differences were found with respect to clinical characteristics,irrespective of H.pylori infection.CONCLUSION:Idiopathic PUB has unique clinical characteristics such as re-bleeding after initial hemostasis upon admission.Therefore,these patients need to undergo close surveillance upon admission.

Small bowel ulcerative lesions are common in elderly NSAIDs users with peptic ulcer bleeding

AIM: To determine the frequency of small bowel ulcerative lesions in patients with peptic ulcer and define the significance of those lesions. METHODS: In our prospective study, 60 consecutive elderly patients with upper gastrointestinal bleeding from a peptic ulceration(cases) and 60 matched patients with a non-bleeding peptic ulcer(controls) underwent small bowel capsule endoscopy, after a negative colonoscopy(compulsory in our institution). Controls were evaluated for non-bleeding indications. Known or suspected chronic inflammatory conditions and medication that could harm the gut were excluded. During capsule endoscopy, small bowel ulcerative lesions were counted thoroughly and classified according to Graham classification. Other small bowellesions were also recorded. Peptic ulcer bleeding was controlled endoscopically, when adequate, proton pump inhibitors were started in both cases and controls, and Helicobacter pylori eradicated whenever present. Both cases and controls were followed up for a year. In case of bleeding recurrence upper gastrointestinal endoscopy was repeated and whenever it remained unexplained it was followed by repeat colonoscopy and capsule endoscopy.RESULTS: Forty(67%) cases and 18(30%) controls presented small bowel erosions(P = 0.0001), while 22(37%) cases and 4(8%) controls presented small bowel ulcers(P < 0.0001). Among non-steroidal antiinflammatory drug(NSAID) consumers, 39(95%) cases and 17(33%) controls presented small bowel erosions(P < 0.0001), while 22(55%) cases and 4(10%) controls presented small bowel ulcers(P < 0.0001). Small bowel ulcerative lesions were infrequent among patients not consuming NSAIDs. Mean entry hemoglobin was 9.3(SD = 1.4) g/d L in cases with small bowel ulcerative lesions and 10.5(SD = 1.3) g/dL in those without(P = 0.002). Cases with small bowel ulcers necessitate more units of packed red blood cells. During their hospitalization, 6(27%) cases with small bowel ulcers presented bleeding recurrence most possibly attributed to small bowel ulcers, nevertheless 30-d mortality was zero. Presence of chronic obstructive lung disease and diabetes was related with unexplained recurrence of hemorrhage in logistic regression analysis, while absence of small bowel ulcers was protective(relative risk 0.13, P = 0.05).CONCLUSION: Among NSAID consumers, more bleeders than non-bleeders with peptic ulcers present small bowel ulcers; lesions related to more severe bleeding and unexplained episodes of bleeding recurrence.

One fifth of hospitalizations for peptic ulcer-related bleeding are potentially preventable

AIM: To calculate the proportion of potentially preventable hospitalizations due to peptic ulcer disease (PUD), erosive gastritis (EG) or duodenitis (ED).

Helicobacter pylori-negative,non-steroidal anti-inflammatory drug:Negative idiopathic ulcers in Asia

Since the discovery of Helicobacter pylori(H.pylori)infection in the stomach,the bacteria infection and non-steroidal anti-inflammatory drugs(NSAIDs)use had been considered to be the 2 main causes of peptic ulcers.However,there have been recent reports of an increase in the proportion of peptic ulcers without these known risk factors;these are termed idiopathic peptic ulcers.Such trend was firstly indicated in 1990s from some reports in North America.In Asia,numerous studies reported that idiopathic ulcers accounted for a small percentage of all ulcers in the 1990s,but in the2000s,multiple studies reported that the proportion of idiopathic ulcers had reached 10%-30%,indicating that the incidence of idiopathic ulcers in Asia has also been rising in recent years.While a decline in H.pylori infection rates of general population in Asia is seen as the main reason for the increased incidence of idiopathic ulcers,it is also possible that the absolute number of idiopathic ulcer cases has increased.Advanced age,serious systemic complication,and psychological stress are considered to be the potential risk factors for idiopathic ulcers.Management of idiopathic ulcers is challenging,at present,because there is no effective preventative measure against recurrence in contrast with cases of H.pylori-positive ulcers and NSAIDs-induced ulcers.As it is expected that H.pylori infection rates in Asia will decline further in the future,measures to treat idiopathic ulcers will also likely become more important.

Clinical characteristics of peptic ulcer perforation in Korea

AIM To elucidate the epidemiological characteristics and associated risk factors of perforated peptic ulcer(PPU).METHODS We retrospectively reviewed medical records of patients who were diagnosed with benign PPU from 2010 through 2015 at 6 Hallym university-affiliated hospitals.RESULTS A total of 396 patients were identified with postoperative complication rate of 9.1% and mortality rate of 0.8%. Among 174(43.9%) patients who were examined for Helicobacter pylori(H. pylori) infection, 78(44.8%) patients were positive for H. pylori infection, 21(12.1%) were on non-steroidal anti-inflammatory drugs(NSAIDs) therapy, and 80(46%) patients were neither infected of H. pylori nor treated by any kinds of NSAIDs. Multivariate analysis indicated that older age(OR = 1.09, 95%CI: 1.04-1.16) and comorbidity(OR = 4.11, 95%CI: 1.03-16.48) were risk factors for NSAID-associated PPU compared with non-H. pylori, non-NSAID associated PPU and older age(OR = 1.04, 95%CI: 1.02-1.07) and alcohol consumption(OR = 2.08, 95%CI: 1.05-4.13) were risk factors for non-H. pylori, non-NSAID associated PPU compared with solely H. pylori positive PPU.CONCLUSION Elderly patients with comorbidities are associated with NSAIDs-associated PPU. Non-H. pylori, non-NSAID peptic ulcer is important etiology of PPU and alcohol consumption is associated risk factor.

A study of the changes in the cause of peptic ulcer bleeding

AIM: To clarify the frequency of and changes in the cause of peptic ulcer bleeding. METHODS: This study retrospectively evaluated the out- and inpatients who underwent endoscopy between 2002 to 2008. The subjects were patients presenting with peptic ulcer bleeding. The details of these patients were obtained from their endoscopic reports and medical records. RESULTS: The rates of Helicobacter pylori (H. pylori ) infection were significantly low (P = 0.039), while the proportion of nonsteroidal antiinflammatory drugs (NSAIDs) users and vascular disease significantly increased over the period studied (P = 0.034 and P = 0.04, respectively). However, there was no significant difference in the proportion of low-dose aspirin users (P = 0.832).CONCLUSION: It's found that the primary cause of peptic ulcer bleeding changed from H. pylori infection to use of NSAIDs over the 7-year period of study. It seems that the number of low-dose aspirin users has increased with the increase in the proportion of vascular disease. It is necessary to take measures to prevent peptic ulcer bleeding among NSAIDs and low dose aspirin users.

Role of dietary polyphenols in the management of peptic ulcer

Peptic ulcer disease is a multifactorial and complex disease involving gastric and duodenal ulcers.Despite medical advances,the management of peptic ulcer and its complications remains a challenge,with high morbidity and death rates for the disease.An accumulating body of evidence suggests that,among a broad reach of natural molecules,dietary polyphenols with multiple biological mechanisms of action play a pivotal part in the management of gastric and duodenal ulcers.The current review confirmed that dietary polyphenols possess protective and therapeutic potential in peptic ulcer mediated by:improving cytoprotection,re-epithelialization,neovascularization,and angiogenesis; up-regulating tissue growth factors and prostaglandins; down-regulating anti-angiogenic factors; enhancing endothelial nitric oxide synthasederived NO; suppressing oxidative mucosal damage; amplifying antioxidant performance,antacid,and antisecretory activity; increasing endogenous mucosal defensive agents; and blocking Helicobacter pylori colonization associated gastric morphological changes and gastroduodenal inflammation and ulceration.In addition,anti-inflammatory activity due to downregulation of proinflammatory cytokines and cellular and int e r c e llular adhe s ion age nt s,s uppr e s s ing leukocyte-endothelium interaction,inhibiting nuclear signaling pathways of inflammatory process,and modulating intracellular transduction and transcription pathways have key roles in the anti-ulcer action of dietary polyphenols.In conclusion,administration of a significant amount of dietary polyphenols in the human diet or as part of dietary supplementation along with conventional treatment can result in perfect security and treatment of peptic ulcer.Further welldesigned preclinical and clinical tests are recommended in order to recognize higher levels of evidence for the confirmation of bioefficacy and safety of dietary polyphenols in the management of peptic ulcer.

Changing trends and characteristics of peptic ulcer disease:A multicenter study from 2010 to 2019 in Korea

BACKGROUND The clinical trend and characteristics of peptic ulcer disease(PUD)have not fully been investigated in the past decade.AIM To evaluate the changing trends and characteristics of PUD according to age and METHODS We analyzed seven hospital databases converted into the Observational Medical Outcomes Partnership-Common Data Model between 2010 and 2019.We classified patients with PUD who underwent rapid urease tests or Helicobacter pylori(H.pylori)serology into three groups:H.pylori-related,drug[nonsteroidal anti-inflammatory drugs(NSAIDs)or aspirin]-related,and idiopathic(H.pylori/NSAID/aspirin-negative)PUD and compared the yearly trends and characteristics among the three groups.RESULTS We included 26785 patients in 7 databases,and the proportion of old age(≥65 years)was 38.8%.The overall number of PUD exhibited no decrease,whereas PUD in old age revealed an increasing trend(P=0.01 for trend).Of the 19601 patients,41.8%had H.pylori-related,36.1%had drug-related,and 22.1%had idiopathic PUD.H.pylorirelated PUD exhibited a decreasing trend after 2014(P=0.01),drug-related PUD demonstrated an increasing trend(P=0.04),and idiopathic PUD showed an increasing trend in the old-age group(P=0.01)during 10 years.Patients with drug-related PUD had significantly more comorbidities and concomitant ulcerogenic drugs.The idiopathic PUD group had a significantly higher number of patients with chronic liver disease.CONCLUSION With the aging population increase,the effects of concomitant ulcerogenic drugs and preventive strategies should be investigated in drug-induced PUD.Further studies are required to clarify the relationship between idiopathic PUD and chronic liver disease.

Treatment of Peptic Ulcer with Xiao Jianzhong Tang—A Report of 80 Cases

With Xiao Jianzhong Tang (小建中汤), the author has successfully treated 80 cases of peptic ulcer. The therapeutic effects obtained were compared with that of the Western medicine. A report follows.

Interaction between Helicobacter pylori infection, nonsteroidal anti-inflammatory drugs and/or low-dose aspirin use: Old question new insights

Previous reports clearly demonstrated that Helicobacter pylori(H.pylori)infection,nonsteroidal anti-inflammatory drugs(NSAID)or low dose aspirin(ASA)use significantly and independently increased the risk for the development of peptic ulcer disease.Today,the presence of H.pylori infection associated with low dose ASA and/or NSAID use in the same patient is becoming more frequent and therefore the potential interaction between these factors and the consequences of it has important implications.Whether NSAID intake in the presence of H.pylori infection may further increase the risk of peptic ulcer carried by the presence of only one risk factor is still a matter of debate.Studies on the interaction between the two risk factors yielded conflicting data and no consensus has been reached in the last years.In addition,the interaction between H.pylori infection and low-dose ASA remains even more controversial.In real clinical practice,we can find different clinical scenarios involving these three factors associated with the presence of different gastrointestinal and cardiovascular risk factors.These huge variety of possible combinations greatly hinder the decision making process of physicians.

Functional dyspepsia of ulcer-dysmotility type:clinical incidence and therapeutic strategy

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黄连素+四联疗法治疗幽门螺杆菌阳性消化性溃疡的临床效果分析

目的探究黄连素(别称:盐酸小檗碱)与四联疗法联合用药方案治疗幽门螺杆菌(Hp)阳性消化性溃疡的临床效果,为临床医师选择合理用药方案提供参考。方法204例Hp阳性消化性溃疡患者为研究对象,采用随机数字表法分为对照组和观察组,每组102例。对照组患者接受常规四联疗法治疗,观察组采用黄连素与四联疗法联合治疗。比较两组患者症状改善时间、Hp清除率及复发率、临床治疗效果、不良反应发生率。结果观察组患者反酸、嗳气、腹痛消失时间与溃疡愈合时间分别为(2.95±0.51)、(3.85±0.44)、(5.65±0.88)、(8.74±0.85)d,较对照组的(4.35±0.85)、(6.85±0.61)、(7.51±1.38)、(12.45±1.28)d短(P<0.05)。观察组患者Hp清除率及复发率分别为96.1%、3.9%,对照组患者分别为80.4%、17.6%,两组比较,观察组患者Hp清除率高,复发率低(P<0.05)。观察组患者治疗总有效率为98.0%,对照组为90.2%,两组比较,观察组较高(P<0.05)。观察组患者不良反应发生率为2.0%(2/102),与对照组的3.9%(4/102)比较无差异(P>0.05)。结论对Hp阳性消化性溃疡患者实施四联疗法治疗时联合黄连素可以快速改善临床症状,提升治疗效果,同时还能提高Hp清除率,降低复发率,值得推广。

艾普拉唑与奥美拉唑注射用药对消化道溃疡出血的疗效

目的 探究艾普拉唑与奥美拉唑注射用药对消化道溃疡出血的疗效。方法 选取104例消化性溃疡出血患者为研究对象,遵循随机分组的原则分为观察组(n=53)和对照组(n=51)。对照组采用奥美拉唑注射用药,治疗组采用艾普拉唑注射用药。比较2组患者治疗3 d内止血率、治疗7 d内再出血率、输血率和住院时间,评估2组患者治疗前、治疗3 d后血清炎性因子白细胞介素-6(interleukin-6,IL-6)、应激反应指标降钙素原(procalcitonin,PCT)、生长因子[表皮生长因子(epidermal growth factor,EGF)、碱性成纤维细胞生长因子(basic fibroblast growth factor,BFGF)]和凝血功能[血浆凝血酶原时间(plasma prothrombin time,PT)、活化部分凝血活酶时间(activated partial thromboplastin time,APTT)]水平,记录2组患者治疗期间不良反应的发生情况。结果 2组患者治疗3 d内止血率、治疗7 d内再出血率、输血率和住院时间比较,差异均无统计学意义(P>0.05);治疗3 d后,2组患者血清IL-6、PCT、PT和APTT均较治疗前降低,且观察组均低于同期对照组(P<0.05);2组患者EGF和BFGF水平均较治疗前升高,且观察组高于同期对照组(P<0.05);2组不良反应发生率比较差异无统计学意义(P>0.05)。结论 艾普拉唑与奥美拉唑对消化性溃疡出血的止血效果相近,但艾普拉唑能有效减轻患者炎性反应及应激反应,能促进患者溃疡修复,且安全性较好。

消化性溃疡患者并发上消化道出血的危险因素分析

目的分析探讨消化性溃疡(PU)患者并发上消化道出血(UGH)的危险因素。方法选取2021年4月至2022年4月郑州市第九人民医院收治的90例PU患者作为研究对象,收集患者性别、年龄、溃疡长径、溃疡病程、溃疡部位、职业、有无吸烟史、有无饮酒史、是否合并幽门螺杆菌感染、入院时血清单核细胞趋化蛋白-1(MCP-1)水平、入院时CD4+水平、入院时CD8+水平、有无高血压病史、有无糖尿病病史、是否长时间应用非甾体抗炎药、是否合并UGH等资料,并根据患者是否合并UGH将其分为并发UGH组和未并发UGH组,多因素Logistic回归分析PU患者并发UGH的危险因素。结果90例PU患者中22例(24.44%)患者合并UGH,设为并发UGH组;68例(75.56%)患者未合并UGH,设为未并发UGH组。单因素分析结果显示,并发UGH组有饮酒史、长时间应用非甾体抗炎药患者比例明显高于未并发UGH组(χ^(2)=17.113、10.399,P<0.001、P=0.001),血清MCP-1水平、CD4+水平明显高于未并发UGH组(t=18.595、4.757,P均<0.001);多因素Logistic回归分析结果显示,有饮酒史、长时间应用非甾体抗炎药、血清MCP-1高水平、CD4+高水平是PU患者并发UGH的独立危险因素(95%CI为3.386~30.422、1.805~14.281、1.047~1.131、1.098~1.349,P<0.001、P=0.002、P<0.001、P<0.001)。结论PU患者并发UGH与饮酒史、非甾体抗炎药应用史以及MCP-1与CD4+水平密切相关,临床应予以重点关注,及时根据患者具体情况采取针对性干预措施,以预防UGH的发生。

灭Hp胶囊与新三联并用对溃疡愈合质量及溃疡复发的影响

目的 观察灭Hp胶囊与新三联并用对消化性溃疡的溃疡愈合质量及溃疡复发的影响。方法 75例活动期消化性溃疡并Hp阳性患者随机分为 3组 :A组 (新三联组 ) :口服兰索拉唑 30mg (1次 /d) +克拉霉素 2 5 0mg(2次 /d) +阿莫西林 5 0 0mg (2次 /d) ,连用 10d ;B组 (灭Hp胶囊四联组 ) :口服新三联 +灭Hp胶囊 6粒 (2次 /d) ,连用 2 8d;C组 (安慰剂组 ) :口服胃舒平 3片 (2次 /d) ,连用 2 8d。疗程结束后 4周复查胃镜 ,观察Hp根治和溃疡愈合情况 ,对溃疡愈合者行光镜及电镜检查 ,评价溃疡愈合质量 ,并停服所有药物 ,随访 5年。结果 A、B两组患者溃疡愈合率、Hp根治率分别为 10 0 0 %、 96 4 % ,88 0 %、 92 0 % ;与安慰剂组的溃疡愈合率 (2 0 0 % )、Hp根治率 (0 )间差别均有显著性意义 (P <0 0 0 5 )。A、B两组与C组的溃疡愈合质量间的差别亦有显著性意义 (P <0 0 5 )。A组和B组溃疡复发率分别为 4 0 %和 10 0 % ,明显低于安慰剂的溃疡复发率 (10 0 % ) ,溃疡复发者均溃疡愈合质量不佳。结论 灭Hp胶囊四联疗法不但具有与新三联相当的Hp根治率和溃疡愈合率 ,而且更有显著提高溃疡愈合质量。

非甾体抗炎药致消化性溃疡出血临床分析

为研究非甾体抗炎药 (NSAIDs)致消化性溃疡出血的临床特征。笔者对解放军第 2 10医院消化性溃疡出血住院患者的临床资料按照出血前 10天内是否服用过NSAIDs分为两组进行比较。结果显示 ,2 6 2例消化性溃疡出血患者中有 18 32 %服用过NSAIDs。两组患者的性别、消化性溃疡史、出血程度、病变大小及部位比较无显著性差异 (P >0 0 5 ) ,但NSAIDs组患者的年龄偏大 ,较多患者有消化道出血史、心血管病史 ,出血前消化道症状不明显 ,溃疡更易多发 ,平均住院天数明显减少 (P <0 0 5 )。

法莫替丁不良反应的回顾性分析

目的:分析国内、外文献资料中法莫替丁不良反应报告的情况,了解法莫替丁不良反应的发生规律。方法:国内1980年～2004年的法莫替丁药物不良反应报告通过检索《中国期刊全文数据库》获得,国外1980年～2004年的法莫替丁药物不良反应报告通过检索MEDLINE数据库获得。结果:国内文献资料中共检出41例法莫替丁药物不良反应病例,最多见的是皮肤及其附件损害和中枢神经系统损害;国外文献资料中共检出140例法莫替丁药物不良反应病例,最多见的是中枢神经系统损害和真菌过度生长。结论:中枢神经系统损害是国内外法莫替丁药物不良反应文献报道的病例中共有的最常见的不良反应,与老年病人用药、肾功能不全病人用药及超剂量用药有关,应引起临床重视。

非甾体类抗炎药相关性溃疡并出血临床特征

【目的】总结分析非甾体类抗炎药相关性溃疡并出血的临床特征。【方法】回顾性分析我们科2007年2月至2011年1月4年间收治的非甾体类抗炎药相关性溃疡并出血住院患者69例的临床资料,与同期未服用非甾体类抗炎药的消化性溃疡并出血患者的临床资料进行比较与分析。【结果】NSAID组的69例患者在年龄构成,合并使用抗凝药物及糖皮质激素,腹痛症状,溃疡发生部位与数量,与消化性溃疡并出血的非NSAID组比较,差异具有统计学意义(P<0.05)。【结论】非甾体类抗炎药相关溃疡并出血引起腹痛症状较少,胃溃疡发生率高于十二指肠溃疡,多发溃疡发生率较高,在60岁以上老年人多见,导致60岁以上病例贫血程度更严重。