消化道出血并发急性心肌梗死的相关因素分析  

The relative factors analysis of gastrointestinal hemorrhage complicated with acute myocardial infarction

作　　者：杨艳[1] 周中银[1] 陈璐[1] YANG Yan;ZHOU Zhongyin;CHEN Lu(Department of Gastroenterology,Renmin Hospital of Wuhan University,Key Laboratory of Digestive System Diseases,Wuhan 430060,China)

机构地区：[1]武汉大学人民医院消化内科,消化系统疾病湖北省重点实验室,湖北武汉430060

出　　处：《胃肠病学和肝病学杂志》2018年第7期765-768,共4页Chinese Journal of Gastroenterology and Hepatology

基　　金：湖北省公益性项目(2013BKB013);湖北省自然科学基金(2011CHB025)

摘　　要：目的研究消化道出血并发急性心肌梗死(acute myocardial infarction,AMI)的相关影响因素。方法选取2014年12月至2016年12月因消化道出血于武汉大学人民医院就诊的920例患者,其中24例并发AMI患者为AMI组,另896例未并发AMI患者为非AMI组,对所有患者的临床资料进行回顾性分析。结果年龄≥70岁、高血压、冠心病、糖尿病及慢性肾脏病病史、入院前近期有阿司匹林服用史的患者AMI发生率较高;用ROC曲线对血红蛋白(HB)进行分析,得出ROC曲线下面积(AUC)为0.791,最佳截断值(cut-off值)为79.5 g/L,相应的灵敏度和特异度分别为73.5%和81.1%。将年龄≥70岁、高血压、冠心病、糖尿病及慢性肾脏病病史、入院前近期有阿司匹林服用史及HB<79.5 g/L进行多元Logistics回归分析,发现年龄≥70岁(OR=3.65,95%CI:1.34~9.95,P=0.011)、冠心病病史(OR=2.94,95%CI:1.09~7.88,P=0.033)和HB<79.5 g/L(OR=0.103,95%CI:0.030~0.353,P=0.000)是消化道出血并发AMI的独立危险因素。AMI组中,有11例于住院期间死亡,病死率为45.8%,显著高于非AMI组(4.5%)(P<0.001)。结论并发AMI可增加消化道出血的病死率,HB浓度<79.5 g/L、年龄≥70岁及冠心病病史是消化道出血并发AMI的独立危险因素。Objective To investigate the relative factors of gastrointestinal hemorrhage complicated with acute myocardial infarction（ AMI）. Methods Nine hundred and twenty patients with gastrointestinal hemorrhage in Remin Hospital of Wuhan University were selected from Dec. 2014 to Dec. 2016. Of which 24 patients combined with AMI were defined as AMI group,the other 896 cases combined without-AMI were defined as non-AMI group. The clinical data of all patients were analyzed retrospectively. Results The patients aged more than 70 years old,hypertension,coronary heart disease,diabetes and chronic kidney disease,the recent history of taking Aspirin before admission had a higher incidence of AMI. The ROC curve of hemoglobin（ HB） values showed that the area under the ROC curve（ AUC）was 0. 791,the optimal cut-off value was 79. 5 g/L,and the relative sensitivity and specificity were 73. 5% and81. 1%,respectively. Age more than 70 years old（ OR = 3. 65,95% CI： 1. 34-9. 95,P = 0. 011）,coronary heart disease（ OR = 2. 94,95% CI： 1. 09-7. 88,P = 0. 033） and HB 79. 5 g/L（ OR = 0. 103,95% CI： 0. 030-0. 353,P = 0. 000） were the independent risk factors of AMI in gastrointestinal bleeding. In AMI group,11 patients died during hospitalization,with a mortality rate of 45. 8%,which was significantly higher than that in non-AMI group（ 4. 5%）（ P〈0. 001）. Conclusion Concurrent AMI can increase the mortality of gastrointestinal hemorrhage. HB concentration below 79. 5 g/L,age more than 70 years old and coronary heart disease history are independent risk factors of gastrointestinal hemorrhage complicated with AMI.

关 键 词：消化道出血 急性心肌梗死 危险因素 

分 类 号：R57[医药卫生—消化系统]