摘要
目的观察非甾体类抗炎药(NSAIDs)相关性上消化道出血患者的凝血相关指标变化,并探讨其危险因素。方法选取108例NSAIDs相关性上消化道出血患者设为出血组,另选取108例服用NSAIDs但未发生上消化道出血患者设为非出血组。比较2组患者的临床资料和凝血相关指标[活化部分凝血活酶时间(APTT)、凝血酶时间(TT)、凝血酶原时间(PT)、纤维蛋白原(Fib)、D-二聚体(D-D)和血小板(PLT)]水平,并分析NSAIDs相关性上消化道出血的危险因素。结果出血组年龄、有吸烟史者占比、有饮酒史者占比、幽门螺杆菌(Hp)感染率、有冠心病史者占比、有脑血管病史者占比、有慢性胃炎史者占比、NSAIDs用药时间>12个月者占比、阿司匹林用药率、≥2种NSAIDs联合用药率、螺内酯用药率均高于非出血组,质子泵抑制剂(PPI)、胃黏膜保护剂使用率均低于非出血组,差异有统计学意义(P<0.05或P<0.01);2组PT、TT、APTT、Fib、D-D、PLT水平比较,差异均无统计学意义(P>0.05)。多因素Logistic回归分析显示,使用PPI、使用胃黏膜保护剂是NSAIDs相关性上消化道出血的独立保护因素(P<0.05或P<0.01),高龄、吸烟、饮酒、合并Hp感染、冠心病、脑血管病、慢性胃炎和服用阿司匹林、服用≥2种NSAIDs、NSAIDs用药时间长、联用螺内酯、联用氯吡格雷是NSAIDs相关性上消化道出血的独立危险因素(P<0.05或P<0.01)。结论NSAIDs相关性上消化道出血患者的凝血相关指标相较于未发生上消化道出血患者并无显著变化,但高龄、吸烟、饮酒、有心脑血管病史、Hp感染、有慢性胃炎病史、长期使用NSAIDs或多药联用的患者更易发生NSAIDs相关性上消化道出血。针对高危因素实施个体化治疗并给予PPI、胃黏膜保护剂,可预防NSAIDs相关性上消化道出血的发生。
Objective To observe the changes of coagulation-related indicators in patients with gastrointestinal bleeding induced by non-steroidal anti-inflammatory drugs(NSAIDs) and to explore its risk factors. Methods A total of 108 patients with gastrointestinal bleeding induced by NSAIDs were selected as bleeding group, and 108 patients who administrated NSAIDs without gastrointestinal bleeding were selected as non-bleeding group. The clinical materials and coagulation-related indicators [activated partial thromboplastin time(APTT), thrombin time(TT), prothrombin time(PT), fibrinogen(Fib), D-dimer(D-D) and platelet count(PLT)] of the two groups were compared, and the risk factors of NSAIDS-related upper gastrointestinal bleeding were analyzed. Results The age, proportions of patients with smoking history and drinking, Helicobacter pylori(Hp) infection rate, proportion of patients with a history of cerebrovascular disease, proportion of patients with a history of chronic gastritis, proportion of patients with a history of medication time of NSAIDs >12 months, medication rate of aspirin,rate of combination medication ≥2 kinds of NSAIDs,and medication rate of spironolactone in the bleeding group were higher than those in the non-bleeding group,and the usage rates of proton pump inhibitor( PPI) and gastric mucosal protective agent were lower than those in the control group( P < 0. 05 or P < 0. 01). There were no statistically significant differences in PT,TT,APTT,Fib,D-D and PLT between the two groups( P > 0. 05). Multivariate Logistic regression analysis showed that use of PPI and gastric mucosal protective agents were protective factors for gastrointestinal bleeding induced by NSAIDs( P < 0. 05 or P < 0. 01),while older age,smoking,drinking,complicating with Hp infection,coronary heart disease,cerebrovascular diseases,chronic gastritis,administration of aspirin,administration of ≥2 NSAIDs medicine,NSAIDs medication for a long time,combined administration of spironolactone and combined administration of clopidogrel were independent risk factors of gastrointestinal bleeding( P < 0. 05 or P < 0. 01). Conclusion Patients with gastrointestinal bleeding induced by NSAIDs have no significant change in coagulation-related indicators,but those with advanced age,smoking and drinking,history of cardiovascular and cerebrovascular diseases,Hp infection or history of chronic gastritis,long-term use of NSAIDs or multidrug combination are more likely to develop NSAIDs-related gastrointestinal bleeding. Individualized treatment for high-risk factors,PPI and gastric mucosal protective agents have preventive effects for gastrointestinal bleeding induced by NSAIDs.
作者
邓园园
黄应文
熊红
卢水焕
周先宝
贺学强
DENG Yuanyuan;HUANG Yingwen;XIONG Hong;LU Shuihuan;ZHOU Xianbao;HE Xueqiang(Department of Gastroenterology,the 924th Hospital of the Joint Logistic Support Force of the People′s Liberation Army,Guilin,Guangxi,541000)
出处
《实用临床医药杂志》
CAS
2022年第7期13-17,21,共6页
Journal of Clinical Medicine in Practice
基金
广西壮族自治区卫生健康委员会自筹经费科研项目(Z20201300)。
关键词
非甾体类抗炎药
消化道出血
凝血功能
危险因素
胃黏膜保护剂
质子泵抑制剂
non-steroidal anti-inflammatory drugs
gastrointestinal bleeding
coagulation function
risk factors
gastric mucosa protectant
proton pump inhibitor
