急性冠状动脉综合征患者经皮冠状动脉介入治疗围术期合并上消化道出血的预后  

Prognosis in acute coronary syndrome patients undergoing percutaneous coronary intervention combined with perioperative upper gastrointestinal bleeding

作　　者：赵晓琳 黄坤[1] 杨友鹏 高峰[2] 程建平[1] 于久飞[1] Zhao Xiaolin;Huang Kun;Yang Youpeng;Gao Feng;Cheng Jianping;Yu Jiufei(Department of Gastrointestinal Oncology,Civil Aviation General Hospital,Beijing 100123,China;Department of Cardiology,Civil Aviation General Hospital,Beijing 100123,China;Department of Gastrointestinal Medicine,Space Center Hospital,Beijing 100049,China)

机构地区：[1]民航总医院(北京大学民航临床医学院)消化肿瘤科,100123 [2]民航总医院(北京大学民航临床医学院)心内科,100123 [3]航天中心医院(北京大学航天临床医学院)消化内科,100049

出　　处：《中国心血管杂志》2021年第2期119-122,共4页Chinese Journal of Cardiovascular Medicine

基　　金：民航总医院(民航医学中心)院级课题资助项目(201938)。

摘　　要：目的评估急性冠状动脉综合征(ACS)合并围术期上消化道出血(GIB)患者随访1年发生出血事件和缺血事件的风险。方法双中心回顾性病例对照研究。连续纳入2014年12月1日至2019年10月31日在民航总医院和航天中心医院行经皮冠状动脉介入治疗(PCI)的ACS患者,根据围术期是否发生GIB,分为GIB组(69例)和对照组(3513例),比较两组间的基线资料情况,随访出院后1年再发出血情况(BARC出血定义),并分析影响有临床意义出血(BARC 2型、3型和5型)的相关因素。结果GIB的中位出血时间为PCI术后3.0 d,主要原因为胃溃疡(43例,62.3%)和十二指肠溃疡(16例,23.1%)。与对照组相比,出血组患者年龄更大、女性更多、体质指数较低,更易合并高血压、心房颤动、慢性肾脏病和消化性溃疡病史(均为P<0.05)。平均随访(12.4±3.3)个月,与对照组比较,GIB组和对照组的缺血事件(34.8%比27.7%)发生率相似(P>0.05),但GIB组的有临床意义出血(BARC 2型、3型和5型)(17.1%比8.8%)的发生率显著高于对照组(P<0.05)。Logistic多因素回归分析显示:年龄>65岁(RR=1.813)、女性(RR=2.014)、消化性溃疡病史(RR=2.152,95%CI:1.156~4.006)、慢性肾脏病≥2期(RR=1.623,95%CI:1.196~2.202)和口服抗凝剂(RR=1.352)均为影响有临床意义出血的独立危险因素,而质子泵抑制剂为其保护因素(RR=0.573)。结论GIB可显著增加ACS患者短期随访发生出血的风险。女性、老年、消化性溃疡病史、慢性肾脏病≥2期和术前应用口服抗凝剂是其独立危险因素,而质子泵抑制剂可降低再发出血风险。Objective To assess the risk of bleeding events and ischemic events in patients with acute Objective To assess the risk of bleeding events and ischemic events in patients with acute coronary syndrome(ACS)combined with perioperative upper gastrointestinal bleeding(GIB)during a 1-year follow-up.Methods This was a dual-center retrospective case-control study.ACS patients who underwent percutaneous coronary intervention(PCI)at the Civil Aviation General Hospital and Space Center Hospital from December 1,2014 to October 31,2019,were enrolled and divided into the GIB group(69 cases)and the control group(3513 cases).The baseline data was compared between groups.All patients were followed up for 1 year after discharge to observe the risk of bleeding events(BARC type)and the related factor of clinically significant bleeding(BARC type 2 and type 3 and type 5)was analyzed.Results The median bleeding time of GIB was 3.0 d after PCI.The main causes were gastric ulcer(43 cases,62.3%)and duodenal ulcer(16 cases,23.1%).Compared with the control group,patients in GIB group were older,more women,and lower body mass index,and were more likely to have a history of hypertension,atrial fibrillation,chronic kidney disease,and peptic ulcer.The average follow-up was(12.4±3.3)months.Compared with the control group,the incidence of ischemic events(34.8%vs.27.7%)in the GIB group was similar(P>0.05),but the GIB group was associated with an increased risk of clinically significant bleeding(17.1%vs.8.8%)than the control group(P<0.05).Logistic multivariate regression analysis showed:age>65 years(RR=1.813),female(RR=2.014),history of peptic ulcer(RR=2.152),chronic kidney disease≥stage 2(RR=1.623),oral anticoagulants(RR=1.352)were risk factors of clinically significant hemorrhage and proton pump inhibitor was its protective factor(RR=0.573).Conclusions GIB can significantly increase the risk of clinically significant bleeding in ACS patients.Female,advanced age,history of peptic ulcer,chronic kidney disease≥2 and oral anticoagulants before s

关 键 词：消化道出血 急性冠状动脉综合征 预后 危险因素 

分 类 号：R54[医药卫生—心血管疾病]