| 317 | 21 | 60 |
| 下载次数 | 被引频次 | 阅读次数 |
目的总结老年人非甾体抗炎药(NSAIDs)相关性上消化道出血(UGIB)的临床特点。方法收集2013年1月至2018年12月期间218例NSAIDs相关性UGIB患者的临床资料,按照年龄分为老年组(≥65岁)和非老年组(<65岁)。回顾性分析2组患者在诱发出血的药物、预防性胃黏膜保护用药情况、首发症状、内镜表现、再出血率和死亡率等方面的特点。结果 2组患者均以阿司匹林为常用的NSAIDs,老年组联合用药比例高于非老年组(18.1%vs 4.3%,P<0.01);经评估,老年组需要使用胃黏膜保护药物的比例明显高于非老年组(42%vs 22.2%,P<0.01);实际使用胃黏膜保护药物的患者比例,老年组与非老年组均较低(3.8%vs 7.4%,P>0.05);2组患者均以黑粪为常见的首发症状,且多表现为无痛性出血,内镜检查均以消化性溃疡多见,但老年组以胃溃疡多见;老年组出血时停用NSAIDs的比例低于非老年组(83.9%vs 94.2%,P<0.05);老年组再出血率低于非老年组(4.1%vs 14.5%,P<0.05)。结论老年人NSAIDs相关性UGIB以黑粪为首发症状,常表现为消化性溃疡,再出血率较低。应加强患者教育,降低胃肠道黏膜损伤风险。
Abstract：AIM To study the clinical characteristics of upper gastrointestinal bleeding(UGIB) associated with non-steroidal anti-inflammatory drugs(NSAIDs) in the elderly. METHODS The 218 patients with NSAIDs-associated UGIB from January 2013 to December 2018 were divided into the elderly group(≥65 years old) and the non-elderly group(<65 years old) according to their age. The data of 2 groups was retrospective analyzed, including the types of medication, preventive medication for gastric mucosa protection, first symptoms, endoscopic manifestations, rebleeding rate, mortality and other aspects of the characteristics. RESULTS The proportion of NSAIDs commonly used in both groups was aspirin, and the proportion of combined drugs in the elderly group was higher than that in the non-elderly group(18.1% vs 4.3%, P<0.01). The proportion of gastric mucosal protective drugs needed in the elderly group was significantly higher than that in the non-elderly group(42% vs 22.2%, P<0.01).The actual use of protective drugs for gastric mucosa was low in both the elderly group and the non-elder-ly group(3.8% vs 7.4%, P>0.05). Black stool was the common first symptom in both groups, and most of them showed painless bleeding. Peptic ulcer was more common in both groups, but gastric ulcer was more common in the elderly group. The proportion of discontinuation of NSAIDs in the elderly group was lower than that in the non-elderly group(83.9% vs 94.2%, P<0.05).The rate of rebleeding in the elderly group was lower than that in the non-elderly group(4.1% vs 14.5%, P<0.05). CONCLUSION Aspirin is the most commonly used NSAIDs in elderly patients with NSAIDS-associated UGIB, and the proportion of multiple drugs is high, but the utilization rate of gastric mucosal protective drugs is low; the elderly often take black stool as the first symptom, and the abdominal symptoms are more atypical; endoscopic examination is often manifested as peptic ulcer, and gastric ulcer is more common; the rate of rebleeding in the elderly group is lower than that in the non-elderly group.
[1] SOSTRES C,GARGALLO C J,LANAS A.Nonsteroidal anti-inflammatory drugs and upper and lower gastrointestinal mucosal damage[J].Arthritis Res Ther,2013,15(3):1.
[2] 陈金,姚健凤.非甾体类抗炎药致老年人胃肠道不良反应研究进展[J].中华老年病研究电子杂志,2017,4(4):22.
[3] GARCíA-RAYADO G,NAVARRO M,LANAS A.NSAID induced gastrointestinal damage and designing GI-sparing NSAIDs[J].Expert Rev Clin Pharmacol,2018,11(10):1031.
[4] CHI T Y,ZHU H M,ZHANG M.Risk factors associated with nonsteroidal anti-inflammatory drugs (NSAIDs)-induced gastrointestinal bleeding resulting on people over 60 years old in Beijing[J].Medicine,2018,97(18):1.
[5] YAP P R,GOH K L.Non-steroidal anti-inflammatory drugs(NSAIDs) induced dyspepsia[J].Curr Pharm Des,2015,21(35):5073.
[6] 抗血小板药物消化道损伤的预防和治疗中国专家共识组.抗血小板药物消化道损伤的预防和治疗中国专家共识(2012更新版)[J].中华内科杂志,2013,52(3):265.
[7] LAI E C,SHIN J Y,KUBOTA K,et al.Comparative safety of NSAIDs for gastrointestinal events in Asia-Pacific populations:a multi-database,international cohort study[J].Pharmacoepidemiol Drug Saf,2018,27(11):1223.
[8] KOCOGLU H,OGUZ B,DOGAN H,et al.Do NSAIDs and ASA cause more upper gastrointestinal bleeding in elderly than adults?[J].Gastroenterol Res Pract,2016:8419304.
[9] ISSABEAGLOO E,TABATABAEI M,TAGHIZADIEH M.Evaluation the rule of NSAIDs in the creation and worsening of the upper gastrointestinal bleeding[J].Life Sci J,2012,9(4):5091.
[10] SUGISAKI N,IWAKIRI R,TSURUOKA N,et al.A case-control study of the risk of upper gastrointestinal mucosal injuries in patients prescribed concurrent NSAIDs and antithrombotic drugs based on data from the Japanese national claims database of 13 million accumulated patients[J].J Gastroenterol,2018,53(12):1260.
[11] AHSBERG K,HOGLUND P,KIM W H,et al.Impact of aspirin,NSAIDs,warfarin,corticosteroids and SSRIs on the site and outcome of non-variceal upper and lower gastrointestinal bleeding[J].Scand J Gastroenterol,2010,45(12):1404.
[12] KHAN S,MOHAMMAD A,O'ROURKE K P.An audit of the frequency of proton pump inhibitor (PPI) prescription in rheumatoid arthritis (RA) patients taking non-steroidal anti-inflammatory drugs (NSAIDs)[J].Ir J Med Sci,2014,183(4):685.
[13] KIM Y,YOKOYAMA S,WATARI J,et al.Endoscopic and clinical features of gastric ulcers in Japanese patients with or without Helicobacter pylori infection who were using NSAIDs or low-dose aspirin[J].J Gastroenterol,2012,47(8):904.
[14] LOCKREY G,LIM L.Peptic ulcer disease in older people[J].J Pharm Pract Res,2011,41(1):59.
[15] CHAN F K,KYAW M H,CHEONG P K,et al.Proton-pump inhibitor (PPI) versus histamine-2 receptor antagonist (H2RA) for the prevention of recurrent non-variceal upper gastrointestinal bleeding in high-risk users of low-dose aspirin (ASA)[J].Gastroenterology,2016,150(4):188.
[16] TARNAWSKI A S,AHLUWALIA A,JONES M K.Angiogenesis in gastric mucosa:an important component of gastric erosion and ulcer healing and its impairment in aging[J].J Gastroenterol Hepatol,2014,29(Suppl 4):112.
[17] HONG S M,CHUNG H,BAE B S,et al.Recent outcomes and characteristics of non-variceal upper gastrointestinal bleeding in a tertiary referral hospital[J].Gastrointestinal Endoscopy,2015,81(5):579.
[18] K?RKK?INEN J M,MIILUNPOHJA S,RANTANEN T,et al.Alcohol abuse increases rebleeding risk and mortality in patients with non-variceal upper gastrointestinal bleeding[J].Dig Dis Sci,2015,60(12):3714.
[19] ALZOUBAIDI D,LOVAT L B,HAIDRY R.Management of non-variceal upper gastrointestinal bleeding:where are we in 2018 [J].Frontline Gastroenterol,2019,10(1):35.
基本信息:
DOI：10.19577/j.1007-4406.2020.03.005
中图分类号:R971.1
引用信息:
[1]陈金,马建霞,于晓峰,等.老年人非甾体抗炎药相关性上消化道出血的临床特点[J].中国临床药学杂志,2020,29(03):177-181.DOI:10.19577/j.1007-4406.2020.03.005.
基金信息:
十三五重点研发计划(编号2018YFC2000300)
2020-05-25
2020-05-25