维持性血液透析并发上消化道出血的危险因素分析  

Analysis of risk factors of upper gastrointestinal bleeding in maintenance hemodialysis patients

作　　者：曾庆义[1] 周才芳 曾秀琴[1] 梁建忠[1] 姚筱[1] Zeng Qingyi;Zhou Caifang;Zeng Xiuqin;Liang Jianzhong;Yao Xiao(Department of Nephrology,(Huizhou Third People’s Hospital,Huizhou,Guangdong 516002,China)

机构地区：[1]广东省惠州市第三人民医院肾内科,广东惠州516002

出　　处：《中国临床医生杂志》2021年第9期1036-1040,共5页Chinese Journal For Clinicians

基　　金：广东省惠州市科技计划项目(2020Y211)。

摘　　要：目的探讨血清胃蛋白酶原Ⅰ(pepsinogenⅠ,PGⅠ)/胃蛋白酶原Ⅱ(pepsinogenⅡ,PGⅡ)联合纤溶酶原激活物抑制剂-1(plasminogen activator inhibitor 1,PAI-1)水平预测维持性血液透析(maintenance hemodialysis,MHD)并发上消化道出血的价值。方法选取广东省惠州市第三人民医院2020年1月至2020年10月收治的符合MHD治疗指征、计划实施MHD治疗的尿毒症患者220例,均在首次透析治疗前检测血清PGⅠ、PGⅡ、PAI-1水平。随访1年,统计MHD治疗期间上消化道出血发生率;根据患者上消化道出血发生与否分为发生组与未发生组,对比两组患者血清PGⅠ、PGⅡ、PAI-1水平及PGⅠ/PGⅡ;分析血清PGⅠ/PGⅡ、PAI-1水平与MHD并发上消化道出血的关系及对其预测效能。结果上消化道出血发生率为10.45%;发生组患者血清PGⅠ、PGⅡ均高于未发生组患者(P<0.05),PGⅠ/PGⅡ、PAI-1水平均低于未发生组(P<0.05);发生组幽门螺杆菌(helicobacter pylori,Hp)感染、刺激性饮食、贫血、低钙血症、低蛋白血症、透析不充分、血清PGⅠ/PGⅡ偏低、血清PAI-1水平偏低占比均高于未发生组(P<0.05),且上述均是MHD并发上消化道出血的独立危险因素[比值比(odds ratio,OR)分别为5.966、4.345、5.382、6.855、6.514、6.573、6.669、5.801,P<0.05];血清PGⅠ/PGⅡ联合PAI-1水平预测MHD并发上消化道出血的灵敏度、曲线下面积(area under curve,AUC)分别为100.00%、0.961,均高于单独预测(P<0.05),特异度与单独预测差异无显著性(P>0.05)。结论MHD有并发上消化道出血的风险,影响因素多,且其血清PAI-1水平偏低,PGⅠ、PGⅡ水平均偏高,且PGⅠ/PGⅡ偏低,PGⅠ/PGⅡ联合PAI-1水平可预测MHD并发上消化道出血。Objective To investigate the value of serum pepsinogenⅠ(PGⅠ)/pepsinogenⅡ(PGⅡ)combined with plasminogen activator inhibitor-1(PAI-1)in predicting upper gastrointestinal bleeding in maintenance hemodialysis(MHD).Methods The serum levels of PG I,PGⅡand PAI-1 were measured before the first dialysis treatment in 220 uremia patients who met the MHD treatment indication and planned to implement MHD treatment in the third people’s Hospital of Huizhou from January 2020 to October 2020.Follow up for 1 year,the incidence of upper gastrointestinal bleeding during MHD treatment was statistically analyzed.According to whether the upper gastrointestinal bleeding occurred or not,the patients were divided into two groups:the occurrence group and the non occurrence group.The serum levels of PG I,PGⅡ,PAI-1 and PG I/PGⅡwere compared between the two groups.The relationships between serum PGⅠ/PGⅡ,PAI-1 levels and MHD complicated with upper gastrointestinal bleeding and their predictive efficacy were analyzed.Results The incidence of upper gastrointestinal bleeding was 10.45%.The serum levels of PGⅠand PGⅡin the occurrence group were higher than those in the non occurrence group(P<0.05),and,while the levels of PGⅠ/PGⅡand PAI-1 were lower than those in the non occurrence group(P<0.05).Helicobacter pylori(Hp)infection,stimulating diet,anemia,hypocalcemia,hypoproteinemia,inadequate dialysis,low serum PGⅠ/PGⅡand low serum PAI-1 levels were higher in the occurrence group than those in the non occurrence group(P<0.05),and these were independent risk factors for MHD complicated with upper gastrointestinal bleeding[odds ratio(OR)was 5.966,4.345,5.382,6.855,6.514,6.573,6.669 respectively,5.801,P<0.05).The sensitivity and area under curve(AUC)of serum PGⅠ/PGⅡcombined with PAI-1 in predicting MHD complicated with upper gastrointestinal bleeding were 100.00%and 0.961,respectively,which were higher than those of single prediction(P<0.05),and the specificity was not significantly different from that of single pred

关 键 词：维持性血液透析 胃蛋白酶原Ⅰ 胃蛋白酶原Ⅱ 纤溶酶原激活物抑制剂-1 上消化道出血 

分 类 号：R692[医药卫生—泌尿科学]