广东地区上消化道出血病因演变及相关因素分析  

The analysis of etiologic changes and related factors in upper gastrointestinal bleeding in Guangdong region

作　　者：余莲英[1] 王启仪[1] 岑荣英[1] 沙卫红[1] 

机构地区：[1]广东省医学科学院广东省人民医院消化科,广州510080

出　　处：《中华消化杂志》2011年第5期289-293,共5页Chinese Journal of Digestion

基　　金：广东省科技计划项目（20108031600152）

摘　　要：目的探讨近20年来广东地区上消化道出血（UGIB）的病因及死亡率变化。方法回顾性分析1990年1月至2009年10月广东省人民医院确诊的UGIB患者共3140例，按入院时间顺序及年龄分组，对比UGIB病因的变化及其影响因素。结果UGIB患者中男性多于女性，性别比为2．5：1，前后10年性别构成比未发生明显变化；消化性溃疡（PU）出血是中青年（〈60岁）UGIB患者最主要病因，特别是十二指肠溃疡（DU）出血（45．0％），其次为急性胃黏膜病变（AGML）（16．6％）；老年组（≥60岁）患者中，AGML（40．5％）是最主要病因，较中青年（16．6％）明显多（P〈0．01）。前、后10年相比，Pu总体呈下降趋势（57．4％比42．8％，P％0．01），其中DU、复合溃疡出血较前明显减少，（43．8％比27．7％，P〈0．01；7．7％比5．5％，P〈0．05），胃溃疡（7．4％比8．1％，P〉0．05）及食管胃底静脉曲张出血（EVB）（11．7％比12．9％，P〉0．05）相对稳定。AGMI。出血较前明显增加（18．8％比32．4％，P％0．01），已超过DU成为UGIB最主要病因之一。结论PU仍为广东地区UGIB的主要原因，AGML成为老年患者UGIB的另一重要病因，可能与非甾体抗炎药、抗血小板及抗肿瘤药物等使用增加有关。Objective To explore the changes of etiology and mortality of upper gastrointestinal bleeding （UGIB） in the last 20 years in Guangdong region. Methods A total of 3140 UGIB cases diagnosed in Guangdong General Hospital from January 1990 to October 2009 were analyzed with retrospective analysis. Groups were divided according to admission chronological order and age to analyze the causes of UGIB to get the trend of changes and influencing factors. Results UGIB occurred more in men than in women, the gender ratio was 2.5= 1. There was no significant change in gender composition between the first and later 10 years. Peptic ulcer bleeding （PUB） was the main cause of UGIB in young and middle-age patients （age〈60 years）, especially duodenal ulcer （DU） bleeding （45.0%）, and secondary was acute gastric mucosal lesion （AGML） （16.60/oo）. While in elder patients group （age≥60 years）, the main cause of UGIB was AGML （40. 5%）, the frequency was significantly higher compared with the young and middle-age group （40. 5% vs 16. 6%, P〈0.01）. Compared the first 10 years with the later 10 years, the occurrence rate of PUB was overall in downward trend （5？. 4G vs 42. 8%, P〈0.01）, of which DU and compound uleer（CU）bleeding reduced significantly （DU： 43.8% vs 27.7%, P〈0.01 and CU： 7.7%vs 5.5%, P〈0.05）. While the incidence of gastric ulcer （GU） （7.4% vs 8.1% ,P〉0. 05） and esophagogastric variceal bleeding （EVB） （11. 7% vs 12. 9%, P〈0 0.05） remained stable. The occurrence of AGML bleeding significantly increased than before （32. 4% vs 18. 8%, P〈00. 01）, and became one of the most important causes of UGIB. Conclusions PUB is still the most important cause of UGIB in Guangdong region. AGML becomes another important cause of UGIB in elder patients, which may relate to the increasing use of non-steroidal anti-inflammatory drugs （NSAIDs）, anti-platelet and antineoplastic medicine.

关 键 词：胃肠出血 消化性溃疡出血 胃黏膜 抗炎药 非甾类 年龄分布 

分 类 号：R573.2[医药卫生—消化系统]