摘要
目的:探讨服用抗血小板药致消化道出血患者的临床特征及危险因素。方法:采用回顾性研究,选取2021—2022年就诊于该院消化科的合并心脑血管疾病使用抗血小板药[阿司匹林和(或)氯吡格雷]治疗出现消化道出血的患者180例作为观察组,同时选取同期合并心脑血管疾病使用抗血小板药[阿司匹林和(或)氯吡格雷]治疗未出现消化道出血的患者180例作为对照组。分析观察组患者消化道出血的临床特征;收集两组患者的一般人口学资料、生化指标和抗血小板药使用情况;采用Logistic回归分析探讨抗血小板药致消化道出血的影响因素,并建立受试者工作曲线,评估抗血小板药致消化道出血相关影响因素预测消化道出血的准确性。结果:180例出现消化道出血的患者中,首发临床症状占比最多的为黑便(72例,占40.0%),占比最少的为仅大便潜血试验阳性(17例,占9.4%);出血严重程度方面,主要为轻度出血(87例,占48.3%),其次为中度出血(74例,41.1%);贫血严重程度方面,主要为中度贫血(97例,占53.9%),重度贫血最少(35例,占19.4%);内镜下病变情况,主要为糜烂性胃炎(110例,占61.1%),其次为消化性溃疡(38例,占21.1%)。Logistic回归分析结果显示,年龄、高血压病史、消化道疾病史、幽门螺杆菌(Hp)感染、Hp感染合并黏膜萎缩性表现、血红蛋白(Hb)异常、血肌酐(Cr)异常、药物使用种类、疗程、联合应用PPI为抗血小板药致消化道出血的影响因素(P<0.05)。所得因变量联合预测抗血小板药致消化道出血概率,其预测敏感度为0.606,特异度为0.900,约登指数为0.506,界值为0.616,曲线下面积为0.809。结论:抗血小板药致消化道出血多以黑便为首发症状,患者可见轻、中度出血和中度贫血,内镜下病变情况以糜烂性胃炎较多。年龄、高血压病史、消化道疾病史、Hp感染、Hp感染合并黏膜萎缩性表现、Hb异常、Cr异常、药物使用种类、疗程、联合应用PPI为影响抗血小板药致消化道出血的相关因素,临床应针对出血因素进行积极干预。同时,对抗血小板药致消化道出血影响因素进行联合评估具有一定的预测价值。
OBJECTIVE:To explore the clinical characteristics and risk factors of patients with hemorrhage of digestive tract caused by antiplatelet drugs.METHODS:Retrospective study method was used,a total of 180 patients with cardiovascular and cerebrovascular diseases who were treated with antiplatelet drugs[aspirin and(or)clopidogrel]for hemorrhage of digestive tract from 2021 to 2022 in the gastroenterology department of the hospital were extracted as the observation group,and 180 patients with cardiovascular and cerebrovascular diseases who were treated with antiplatelet drugs[aspirin and(or)clopidogrel]during the same period without hemorrhage of digestive tract were extracted as the control group.The clinical characteristics of hemorrhage of digestive tract in the observation group were analyzed.General demographic data,biochemical indexes and the use of antiplatelet drugs were collected.Logistic regression analysis was used to explore the influencing factors of hemorrhage of digestive tract caused by antiplatelet drugs,and the receiver operator characteristic curve was established to evaluate the accuracy of the influencing factors in predicting hemorrhage of digestive tract.RESULTS:Of the 180 patients with hemorrhage of digestive tract,the highest proportion of the first clinical symptoms was black stool(72 cases,40.0%),and the lowest proportion was only stool occult blood test positive(17 cases,9.4%).The proportion of patients with mild bleeding was the highest(87 cases,48.3%),followed by moderate bleeding(74 cases,41.1%).The proportion of patients with moderate anemia took the lead(97 cases,53.9%),while patients with severe anemia were the lowest(35 cases,19.4%).The main endoscopic lesions were erosive gastritis(110 cases,61.1%),followed by peptic ulcer(38 cases,21.1%).Logistic regression analysis showed that age,history of hypertension,history of digestive tract diseases,Helicobacter pylori(Hp)infection,Hp infection complicated with mucosal atrophy,abnormal hemoglobin(Hb),abnormal serum creatinine(Cr),type of drug use,course of treatment,and combination of PPI were the influencing factors for hemorrhage of digestive tract caused by antiplatelet drugs(P<0.05).The obtained dependent variables were combined to predict the probability of hemorrhage of digestive tract caused by antiplatelet drugs,with a predictive sensitivity of 0.606,a specificity of 0.900,a Yoden index of 0.506,a threshold of 0.616,and an area under the curve of 0.809.CONCLUSIONS:The first symptom of hemorrhage of digestive tract caused by antiplatelet drugs is mostly black stool.Mild to moderate bleeding and moderate anemia can be observed.Age,history of hypertension,history of digestive tract diseases,Hp infection,Hp infection complicated with mucosal atrophy,abnormal Hb,abnormal Cr,type of drug use,course of treatment,and combination of PPI are related factors that affect hemorrhage of digestive tract caused by antiplatelet drugs.Clinical intervention should be actively targeted at bleeding factors,and joint evaluation of factors affecting hemorrhage of digestive tract caused by antiplatelet drugs has certain predictive value.
作者
石瑞春
杨志伟
苏国忠
苏丹
金丹
杨小婷
SHI Ruichun;YANG Zhiwei;SU Guozhong;SU Dan;JIN Dan;YANG Xiaoting(Dept.of Gastroenterology,Wuzhong People’s Hospital,Ningxia Wuzhong 751100,China)
出处
《中国医院用药评价与分析》
2023年第8期1011-1015,共5页
Evaluation and Analysis of Drug-use in Hospitals of China
基金
2020年宁夏回族自治区卫生健康系统科研课题(No.2020-NW-084)
宁夏医科大学科研项目(No.XM2019177)。
关键词
抗血小板药
消化道出血
临床特征
危险因素
LOGISTIC回归分析
Antiplatelet drugs
Hemorrhage of digestive tract
Clinical characteristics
Risk factors
Logistic regression analysis
