幽门螺杆菌阴性消化性溃疡并发出血危险因素分析

幽门螺杆菌（H．pylori）是引起消化性溃疡（PU）的重要因素，而H．pylori阴性溃疡在PU中占有一定比例，其病因、临床表现和治疗有其特殊性。目的：分析H．pylori阴性PU并发出血的危险因素，为其预防和治疗提供可靠依据。方法：回顾性分析2004年1月～2007年3月在北京大学第三医院住院治疗的PU患者的病例资料，所有患者均经内镜检查确诊，并经病理学检查排除恶性病变，对其中H．pylori阴性患者行出血相关危险因素分析。结果：共有480例PU患者入选，其中H．pylori阴性120例（25．O％），男95例（79．2％），女25例（20．8％），中位年龄65（19-87）岁；并发出血者共95例（79.2％）。对可能与H．pylori阴性PU并发出血相关的因素行单因素分析，结果显示无腹痛（P=0．015）、溃疡形状为类圆形（P=O．027）、溃疡分期为活动期（P〈0．001）、无反流性食管炎（RE）（P〈0．001）、凝血酶原活动度〈80％（P=-0．034）有统计学意义：进一步行Logistic逐步回归分析，结果显示无腹痛、溃疡分期为活动期、无RE、溃疡最大直径〈20mm有统计学意义（P〈0．05）。结论：无腹痛、溃疡形状为类圆形、分期为活动期、无RE、凝血酶原活动度〈80％与H．pflori阴性PU发生出血相关。无腹痛、溃疡分期为活动期、无RE、溃疡最大直径〈20mm为H．pylori阴性PU发生出血的独立危险因素。

Analysis of Risk Factors of Hemorrhage in Helicobacter pylori-negative Peptic Ulcer

Helicobacter pylori （H. pylori） is one of the most important pathogenic factors of peptic ulcer （PU）, however, some cases which have been referred as H. pylori-negative PU may be caused by other factors and have their specific characteristics in both clinical manifestations and treatment. Aims： To analyze the risk factors of bleeding in H. pylori-negative PU in order to provide a reliable basis for the prevention and treatment of bleeding in these patients. Methods： The Medical records of all PU inpatients diagnosed by endoscopy in Peking University Third Hospital from January 2004 to March 2007 were analyzed retrospectively. Malignant diseases were excluded by pathologic examination. The risk factors of bleeding in H. pylori-negative PU patients were investigated and analyzed. Results： Of the 480 PU cases, 120 （25.0%） were H. pylori-negative, including 95 （79.2%） male and 25 （20.8%） female patients. The median age was 65 （19-87） years. Bleeding occurred in 95 （79.2%） cases of H. pylori-negative PU. Univariate analysis identified 5 statistically significant variables, including without abdominal pain （P=0.015）, round shaped ulcer （P=0.027）, active stage ulcer （P〈0.001）, without reflux esophagitis （RE） （P〈0.001） and thrombinogen activity 〈80% （P=0.034）. Logistic stepwise regression analysis showed that without abdominal pain, active stage ulcer, without RE and maximal ulcer diameter less than 20 mm were correlated with bleeding in H. pylori-negative PU （P〈O.05）. Conclusions： Without abdominal pain, round shaped ulcer, active stage ulcer, without RE and thrombinogen activity 〈80% are correlated with bleeding in H. pylori-negative PU, whereas without abdominal pain, active stage ulcer, without RE and maximal ulcer diameter less than 20 mm are independent risk factors of bleeding in H. pylori-negative PU.