季节及气温对缺血性心脏病患者消化道出血的影响研究  

Effects of Season and Temperature on Gastrointestinal Bleeding in Patients with Ischemic Heart Disease

作　　者：马亮 严海琳 肖雪 杨锦林[1] MA Liang;YAN Hailin;XIAO Xue;YANG Jinlin(Department of Gastroenterology,West China Hospital,Sichuan University,Chengdu 610041,China)

机构地区：[1]四川大学华西医院消化内科,四川省成都市610041

出　　处：《中国全科医学》2022年第21期2589-2596,共8页Chinese General Practice

基　　金：四川大学华西医院学科卓越发展1·3·5工程临床研究孵化项目(2020HXFH039,2020HXFH054);成都市科技局重大科技应用示范项目(2021-YF09-00050-SN)——区域性急性消化道大出血分级联动管理平台。

摘　　要：背景缺血性心脏病(IHD)患者在应激状态等刺激下易发生消化道出血(GIB),反过来GIB严重者可诱发IHD。IHD合并GIB患者面临的死亡风险比单一的IHD或GIB患者更高。季节及气温可能增加IHD合并GIB患者的发病率和死亡风险,有待进一步研究。目的探讨IHD合并GIB的季节分布特点及其与气候温度的关系。方法选取四川大学华西医院2014年1月至2018年12月收治的符合纳入、排除标准的IHD合并GIB住院患者730例为研究对象。通过电子病历系统收集患者的基线资料,包括年龄、性别、吸烟史、饮酒史、经皮冠状动脉介入术(PCI)史、抗血小板药物应用史、抗凝药物应用史、是否合并高血压、是否合并糖尿病、是否合并慢性肾脏病(CKD)、是否合并慢性阻塞性肺疾病(COPD),以及入院时间、IHD类型(稳定型心绞痛和急性冠脉综合征)、GIB部位(非静脉曲张性上消化道出血、静脉曲张性上消化道出血、下消化道出血和不明原因GIB)、离院方式(死亡结局)。从成都市气象局获取2014年1月至2018年12月成都市的气象信息:月平均高温、月平均低温、月平均气温、月温差。根据气候学通用的季节划分方法,结合成都地区的气象特点划分四季:春季(3—5月份)、夏季(6—8月份)、秋季(9—11月份)和冬季(12月—次年2月份)。分析IHD合并GIB患者的季节住院比例、急性冠脉综合征季节发病情况、出血部位季节发病情况、死亡的季节情况。结果IHD合并GIB患者平均年龄(72.8±11.3)岁;男493例,女237例,男、女性别比为2.08∶1。男、女性70~79岁年龄组的占比较高,分别为35.29%(174/493)和39.66%(94/237)。每年7—8月的气温最高,12月、1月的气温最低,每年春季的温差变化大。冬、春季患者住院比例高于夏、秋季(58.8%vs 41.2%,χ^(2)=3.907,P=0.003)。与夏、秋季节相比,春季IHD合并GIB患者住院比例升高(χ^(2)=2.912,P=0.020;χ^(2)=2.567,P=0.033);与夏季�Background Patients with ischemic heart disease(IHD)are prone to gastrointestinal bleeding(GIB)under stress and other stimuli,and in turn severe GIB can induce IHD.IHD patients complicated with GIB are facinga higher mortality risk than those with IHD or GIB alone.Season and temperature may increasethe morbidity and mortality risk of patients with IHD and GIB,but further research is stillneeded.Objective To investigate the seasonal distribution characteristics of IHD complicated with GIB and its correlation with temperature.Methods A total of 730 IHD patients complicated with GIB treated at West China Hospital,Sichuan University,from January 2014 to December 2018 were enrolled as the research objectsbased on inclusion and exclusion criteria.The following baseline data of the patients were collected through the electronic medical record system,including age,sex,history of smoking,drinking,percutaneous coronary intervention(PCI),use of antiplatelet agents and use of anticoagulants;presence or absence of hypertension,diabetes mellitus,chronic kidney disease(CKD)and chronic obstructive pulmonary disease(COPD);time of admission,IHD type(stable angina pectoris and acute coronary syndrome),GIB site(nonvariceal upper GIB,variceal upper GIB,lower GIB and unexplained GIB)and mode of discharge(death outcome).The meteorological dataincluding monthly average high temperature,monthly average low temperature,monthly average temperature and monthly temperature difference from January 2014 to December 2018 in Chengdu were obtained from the Chengdu Meteorological Office.Based on the commonly adopted seasonal division method in climatology and meteorological characteristics of the Chengdu area,the seasons were divided into spring(March,April and May),summer(June,July and August),autumn(September,October and November)and winter(December,January and February).The seasonal hospitalization rate,seasonal incidence of acute coronary syndrome,seasonal incidence of bleeding sites and seasonal mortality of IHD patients complicated with GIB

关 键 词：心肌缺血 胃肠出血 季节 气温 成都 

分 类 号：R542.2[医药卫生—心血管疾病]