幽门螺杆菌感染与经皮冠状动脉介入治疗术后抗血小板治疗诱发上消化道出血的关系  

Relationship Between Helicobacter Pylori Infection and Anti-platelet Therapy Induced Upper Gastrointestinal Bleeding in Patients After Percutaneous Coronary Intervention

作　　者：刘静[1] 张铁亮[2] 戴远辉 黄定[1] 

机构地区：[1]新疆医科大学第一附属医院心脏中心冠心病二科,新疆维吾尔自治区乌鲁木齐市830054 [2]新疆医科大学第一附属医院影像中心放射科,新疆维吾尔自治区乌鲁木齐市830054

出　　处：《中国循环杂志》2016年第11期1060-1063,共4页Chinese Circulation Journal

摘　　要：目的:探讨幽门螺杆菌(Hp)感染与经皮冠状动脉介入治疗(PCI)术后应用抗血小板药物治疗诱发上消化道出血的关系。方法:选取我院行PCI的1 482例患者进行回顾性分析,根据患者术后C-14尿素呼吸实验结果分为Hp阳性患者921例,Hp阴性患者561例(Hp阴性组),同时根据患者是否接受Hp根除治疗将Hp阳性患者分为治疗组387例和非治疗组534例。收集3组患者的一般临床资料,并进行1年随访,对比上消化道出血发生率。结果:3组患者在性别、年龄、合并疾病方面,差异均无统计学意义(P均>0.05)。3组患者随访1年,非治疗组患者上消化道出血率(5.2%)显著高于Hp阴性组(1.8%)和治疗组(1.8%),差异均有统计学意义(P均<0.05)。非治疗组呕血+黑便、黑便发生率(21.4%,57.1%)均高于治疗组(0,14.3%)和Hp阴性组(0,20.0%),差异均有统计学意义(P均<0.05)。非治疗组贫血发生率(100%)显著高于治疗组(57.1%)和Hp阴性组(50.0%),差异均有统计学意义(P均<0.05)。Hp阳性患者中,治疗组1年后Hp阴性率(82.4%)显著高于非治疗组(0),差异有统计学意义(P<0.05)。结论:Hp感染阳性患者PCI术后应用抗血小板药物治疗会加大上消化道出血风险,采取抗Hp治疗具有降低出血风险效果。Objective： To study the relationship between helicobacter pylori（Hp） infection and anti-platelet therapy induced upper gastrointestinal bleeding in patients after percutaneous coronary intervention（PCI）. Methods： A total of 1482 patients received PCI in our hospital were retrospectively analyzed. According to postPCI 14 C breath test, the patients were divided into 2 groups： Hp positive（＋） group, n =921 and Hp negative（-） group, n =561; based on Hp eradication therapy, Hp positive group was further divided into 2 subgroups as Treatment subgroup, n =387 and Non-treatment subgroup, n =534. All patients were followed-up for 1 year to compare the incidence rate of gastrointestinal bleeding among different groups.Results： The gender, age and complications were similar in all patients. The incidence rate of upper gastrointestinal bleeding in Non-treatment subgroup（5.2%） was higher than Hp（-） group（1.8%） and Treatment subgroup（1.8%）, P0.05. Compared with Treatment subgroup and Hp（-） group, Hp（＋） group had more patients with vomiting＋melena and melena（21.4%, 57.1%） vs（0%, 14.3%）, P0.05. The incidence rate of anemia in Non-treatment subgroup（100%） was higher than Treatment subgroup（57.1%） and Hp（-） group（50.0%）, P0.05. With 1 year treatment, the negative conversion ratio of Hp in Treatment subgroup was 82.4%, while it was 0% in Non-treatment subgroup, P0.05.Conclusion： The risk of anti-platelet therapy induced upper gastrointestinal bleeding could be increased in Hp infected patients after PCI; anti-Hp treatment may reduce the risk of bleeding in relevant patients.

关 键 词：幽门螺杆菌 血管成形术 经腔 经皮冠状动脉 抗血小板药物 胃肠出血 

分 类 号：R54[医药卫生—心血管疾病]