多种药物的使用与上消化道出血危险关系的病例对照研究  

Use of Different Drugs and the Risk of Upper Gastrointestinal Bleeding:a Case-control Study

作　　者：陈虹燕[1] 宁琳洪[1] 程姮 刘恩[1] 郭红[1] 

机构地区：[1]第三军医大学新桥医院消化内科,重庆400037

出　　处：《药物流行病学杂志》2016年第4期239-244,共6页Chinese Journal of Pharmacoepidemiology

摘　　要：目的:探讨活血化瘀中药注射剂、螺内酯、肝素等药物与上消化道出血的危险关系。方法:选择临床诊断为上消化道出血的患者912例作为病例组,将同期住院的未发生消化道出血患者1 824例按性别匹配对照组。比较两组患者临床特征及用药差异,采用非条件Logistic回归法对上消化道出血的危险因素进行多因素分析。结果:活血化瘀类中成药、螺内酯、肝素、阿司匹林、氢氯吡格雷、华法林、非选择性非甾体抗炎药、皮质类固醇激素致上消化道出血的调整后比值比(OR)分别为:1.630,2.748,3.488,1.603,1.787,6.646,5.787和3.382;质子泵抑制药(PPI)、H_2受体拮抗药则是上消化道出血的保护因素,上述药物与上消化道出血有关(P<0.05)。而钙离子拮抗药、硝酸酯类药与上消化道出血无关(P>0.05)。病例组高龄患者(≥65岁)、幽门螺杆菌(Hp)感染率、既往消化道出血史、胃和(或)十二指肠溃疡、慢性胃炎、慢性十二指肠炎、糖尿病、恶性肿瘤比例明显高于对照组。结论:活血化瘀类中成药、螺内酯、抗凝血药物的使用会增加上消化道出血事件发生风险,高龄患者(≥65岁)、Hp感染、既往消化道出血史、胃和(或)十二指肠溃疡、慢性胃炎、慢性十二指肠炎、缺血性脑血管事件、糖尿病、恶性肿瘤均是上消化道出血的危险因素。Objective：To evaluate the relationship between upper gastrointestinal bleeding（ UGIB） and different drugs such as traditional Chinese medicine injection having the effect for dispersing blood stasis,spironolactone and heparin etc. Methods：Case group consist of 912 patients who were diagnosed UGIB. Control group were matched with gender of case group,consisting of 1824 patients who were in the same period without gastrointestinal bleeding. The clinical characteristics and differences of used medicines concerned with UGIB were compared in this study,and suspected adverse drug reaction（ ADR） risk factors were statistical analysis by logistic regression. Results：The OR of UGIB among traditional Chinese medicine having the effect for dispersing blood stasis,spironolactone,heparin,aspirin,clopidogrel,warfarin,NSAIDs,steroids were 1. 630,2. 748,3. 488,1. 603,1. 787,6. 646,5. 787 and 3. 382 respectively. The OR of PPI and H_2 receptor antagonist respectively were 0. 025 and 0. 018. All of these drugs above were factors affecting UGIB（ P 〈0. 05）. However,calcium channel blockers and nitrate were not factors affecting UGIB（ P 〉0. 05）. The proportion of old age（ ≥65 years old）,H. Pylori（ Hp） infection,history of gastrointestinal bleeding（ GIB）,peptic ulcer,chronic gastritis,chronic duodenitis,diabetes and cancer in case group were larger than control group. Conclusion：The use of traditional Chinese medicine having the effect for dispersing blood stasis,spironolactone and heparin would result in UGIB. Meanwhile,old age（ ≥65 years old）,Hp infection,history of GIB,peptic ulcer,chronic gastritis,chronic duodenitis,diabetes and cancer were risk factors of UGIB.

关 键 词：上消化道出血 药物 病例对照研究 相对危险度 

分 类 号：R573.2[医药卫生—消化系统]