不同抗栓药物并发非静脉曲张性上消化道出血的临床特征及病因分析

Clinical characteristics and etiology analysis of nonvariceal upper gastrointestinal bleeding in the treatment of different antithrombotic drugs

  • 摘要:
    目的 探讨不同类型口服抗栓药物治疗中并发非静脉曲张性上消化道出血(NVUGIB)的临床特征及病因。
    方法 回顾性分析535例口服抗栓药物治疗中并发NVUGIB患者的临床资料, 按抗栓药物种类不同将患者分为抗血小板组和抗凝组,比较分析2组患者的一般资料、临床特点和病因构成。
    结果 抗血小板组男性占比高于抗凝组,差异有统计学意义(P=0.012)。抗血小板组合并冠心病、高血压、糖尿病患者的占比高于抗凝组,合并房颤、心脏瓣膜病、肺栓塞或深静脉血栓的患者占比低于抗凝组,差异有统计学意义(P < 0.05); 抗血小板组口服药物1个月内发生NVUGIB患者的占比高于抗凝组,差异有统计学意义(P < 0.05); 抗血小板组出现胸闷、胸痛症状患者的占比高于抗凝组,腹痛症状患者的占比低于抗凝组,差异有统计学意义(P < 0.05); 抗血小板组使用抑酸药物患者的占比和Hp感染率高于抗凝组,差异有统计学意义(P < 0.05)。2组NVUGIB的常见病因为消化性溃疡、急性胃黏膜病变、恶性肿瘤。
    结论 口服抗栓药物并发NVUGIB以老年男性最为多见,前3位的病因为消化性溃疡、急性胃黏膜病变和恶性肿瘤。抗血小板与抗凝并发NVUGIB患者的基础疾病、口服抗栓药时间、症状和病因存在一定差异,临床医生需注意鉴别。

     

    Abstract:
    Objective To explore clinical characteristics and etiology of complicating non-variceal upper gastrointestinal bleeding (NVUGIB) patients with different oral antithrombotic drug.
    Methods Clinical data of 535 patients complicated with NVUGIB during oral administration of antithrombotic drugs were retrospectively analyzed and they were divided into antiplatelet group and anticoagulant group according to different types of antithrombotic drugs. General data, clinical characteristics and etiology of patients in the two groups were compared and analyzed.
    Results The proportion of male in the antiplatelet group was higher than that in the anticoagulant group (P=0.012). The proportions of patients complicating coronary heart disease, hypertension and diabetes in the antiplatelet group were higher than that in anticoagulation group, and the proportion of patients complicating atrial fibrillation, heart valve disease, pulmonary embolism or deep vein thrombosis was lower than that in the anticoagulant group (P < 0.05). The proportion of patients with NVUGIB in the antiplatelet group within 1 month after taking the medicine was higher than that in the anticoagulant group (P < 0.05). The proportion of patients with chest tightness and chest pain in the antiplatelet group was higher than that in the anticoagulant group, while the proportion of patients with abdominal pain was lower than that in the anticoagulant group (P < 0.05). The proportion of patients using acid suppressant and Hp infection rate in the antiplatelet group were higher than those in the anticoagulant group (P < 0.05). The common causes of NVUGIB in the two groups were peptic ulcer, acute gastric mucosal lesion and malignant tumor.
    Conclusion NVUGIB with oral antithrombotic therapy usually occur in elderly men. The top three causes are peptic ulcer, acute gastric mucosal lesion and malignant tumor. There are some differences in underlying diseases, oral duration of antithrombotic drugs, symptoms and etiology in antiplatelet and anticoagulant patients with NVUGIB. Thus, clinicians need to pay attention to their difference.

     

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