抗血小板药物治疗老年冠心病致上消化道出血的影响因素分析

Influencing Factors of Upper Gastrointestinal Hemorrhage Caused by Antiplatelet Agents in the Treatment of Coronary Heart Disease in the Elderly

中文关键词: 冠心病  上消化道出血  幽门螺杆菌

英文关键词: coronary heart disease (CHD)  upper gastrointestinal hemorrhage  H. pylori

中文摘要:

      目的 探讨并分析老年冠心病患者服用抗血小板药物后出现上消化道出血情况及影响因素,以预防老年冠心病(CHD)患者上消化道出血的发生.方法 选择复旦大学附属华东医院2015年7月-2016年12月连续诊治的CHD服用抗栓药物治疗后出现上消化道出血的病例70例作为观察组,同时期连续诊治的CHD未发生上消化道出血的病例96例作为对照组,采用回顾调查法观察2组患者基本情况,采用13c尿素呼气试验检测患者幽门螺杆菌(Hp)阳性率;测定血谷丙转氨酶(ALT)、肌酐(Cr)、总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白(LDL-c)及C反应蛋白(CRP)浓度.并按照年龄进一步分为2组(60 ～ 80岁老年人群和＞80岁高龄人群),比较这2组人群的上消化道出血发生情况.结果 2组患者体质指数(BMI)、谷丙转氨酶(ALT)、TG、TC和LDL-C结果比较,差异无统计学意义;观察组患者CRP为(26.00±12.67) mg/L,高于对照组的(22.20±10.95) mg/L,差异有统计学意义(P＜0.05);观察组患者肌酐(Cr)为(97.74±25.49) mg/L,高于对照组的(88.75±21.20) mg/L,差异有统计学意义(P＜0.05);年龄＞80岁、有吸烟史、有消化疾病史、13c尿素呼气试验阳性患者出现上消化道出血比例大,差异有统计学意义(P＜0.05);Logistic回归分析显示高龄、有吸烟史、有消化疾病史、136尿素呼气试验阳性是CHD患者发生上消化道出血的独立危险因素.结论 高龄、吸烟、既往有消化疾病史及存在Hp感染是接受抗血小板治疗的CHD合并上消化道出血的危险因素.临床上治疗CHD同时应积极干预消化道出血危险因素,改善患者预后.

英文摘要:

      Objective To explore the upper gastrointestinal hemorrhage in the elderly with coronary heart disease (CHD) after taking antiplatelet agents and to analyze the influencing factors.Methods 70 CHD patients with upper gastrointestinal hemorrhage after taking antiplatelet agents receiving treatment in Huadong Hospital during the period from July,2015 to Dec.,2016 were selected to be control group and 96 CHD patients with no upper gastrointestinal hemorrhage during thesame period were selected to be control group;a retrospective study was made to the clinical data of the patients in bo th groups;13c urea breath test was made to determine the positive rate of H.pylori in the patients and the levels of alanine aminotransferase (ALT),creatinine (Cr),total cholesterol (TC),triglyceride (TG),low density lipoprotein (LDL-c) and C-reactive protein (CRP) were detected;according to age,all the patients were further divided into 2 groups:old age group (aged from 60 to 80 years old) and advanced age group (aged over 80 years old) and the occurrences of upper gastrointestinal hemorrhage in these 2 groups were compared.Results There existed o statistical difference in BMI,ALT,TG,TC and LDL-c between the 2 groups;the level of CPR of the patients in observation group was higher than that of the patients in control group [(26.00±12.67) mg/L vs (22.20±10.95) mg/L] with a statistical difference (P＜0.05);the level of Cr of the patients in observation group was higher than that of the patients in control group [(97.74±25.49) mg/L vs (88.75±21.20) mg/L]with a statistical difference (P＜0.05);the proportion of upper gastrointestinal hemorrhage occurrence was bigger in patients aged over 80 of positive 13c urea breath test and with the history of smoking and digestive tract diseases,the difference was of statistical significance (P＜ 0.05);Logistic Regression Analysis indicated that advanced old age,history of smoking,history of digestive tract diseases,positive 13c urea breath test were independent risk factors of upper gastrointestinal hemorrhage in CHD patients.Conclusions Advanced old age,smoking,history of digestive tract diseases,H.pylori infection are the risk factors of upper gastrointestinal hemorrhage combined in antiplatelet treatment of CHD patients;certain intervention for digestive tract hemorrhage should be taken while providing treatment of CHD so as to improve the prognosis of the patients.