西藏地区消化性溃疡出血的临床特征研究

背景西藏地处高原，消化性溃疡出血高发，但目前对西藏地区消化性溃疡出血的临床特点以及溃疡出血与再出血的危险因素报道较少见。目的探讨西藏地区消化性溃疡出血的临床特点，以及高危溃疡出血及再出血可能的危险因素。方法选取2017—2020年在西藏自治区人民医院因上消化道出血就诊，且经胃镜检查明确诊断为消化性溃疡出血的住院患者212例。根据胃镜下病变Forrest分级将患者分为高危组（Ⅰa~Ⅱb级）和低危组（Ⅱc级和Ⅲ级）。高危组患者根据是否发生再出血分为再出血亚组和无再出血亚组。分析患者的一般资料和临床特点，并采用多因素Logistic回归分析探究消化性溃疡出血高危情况的影响因素。结果212例患者中，男女比例为5.42∶1；胃溃疡出血125例（59.0%），十二指肠溃疡出血87例（41.0%）；高危组86例（40.6%），低危组126例（59.4%）；再出血亚组12例（14.0%），无再出血亚组74例（86.0%）。高危组血红蛋白（HGB）、尿素氮（BUN）、再出血发生率、住院天数高于低危组（P<0.05）。多因素Logistic回归分析结果显示，HGB〔OR=1.007，95%CI（1.001，1.014），P=0.028〕和BUN〔OR=1.061，95%CI（1.003，1.121），P=0.037〕是消化性溃疡出血高危的独立影响因素。再出血亚组血小板计数（PLT）、白蛋白（ALB）水平低于无再出血亚组（P<0.05）。结论西藏地区消化性溃疡出血患者中，男性多于女性，胃溃疡多于十二指肠溃疡。入院时HGB、BUN水平是高危消化性溃疡出血的独立影响因素。入院时PLT、ALB水平可能是高危消化性溃疡再出血的影响因素。

Clinical Analysis of Peptic Ulcer Bleeding in Tibet

Background Tibet is located on the plateau with a high incidence of peptic ulcer bleeding,but there are few reports about the clinical characteristics of peptic ulcer bleeding,as well as the risk factors of bleeding and rebleeding associated with peptic ulcer in Tibet.Objective To explore the clinical characteristics of peptic ulcer bleeding,and the potential risk factors of bleeding and rebleeding associated with high-risk peptic ulcer in Tibet.Methods A total of 212 hospitalized patients who visited the Tibet Autonomous Region People's Hospital for upper gastrointestinal bleeding and were clearly diagnosed as peptic ulcer bleeding by gastroscopy from 2017 to 2020 were selected.Patients were divided into two groups according to the Forrest classification under endoscopy:high-risk group(Ⅰa-Ⅱb)and low-risk group(Ⅱc andⅢ).The high-risk group was further divided into rebleeding subgroup and non-rebleeding subgroup according to the occurrence of rebleeding.The general data and clinical characteristics of the patients were analyzed,and multivariate Logistic regression analysis was used to explore the influencing factors of the high risk of peptic ulcer bleeding.Results Among 212 patients with peptic ulcer bleeding,the maleto-female ratio was 5.42∶1;including 125 cases(59.0%)with gastric ulcer bleeding,87 cases(41.0%)with duodenal ulcer bleeding;86(40.6%)patients in the high-risk group,and 126(59.4%)in the low-risk group.There were 12(14.0%)patients in the rebleeding subgroup,and 74(86.0%)in the non-rebleeding subgroup.The hemoglobin level(HGB),urea nitrogen(BUN),the rebleeding rate and the length of hospital stay in high-risk group were higher than low-risk group(P<0.05).Multivariate Logistic regression analysis showed that HGB〔OR=1.007,95%CI(1.001,1.014),P=0.028〕and BUN〔OR=1.061,95%CI(1.003,1.121),P=0.037〕were the independent influencing factors for the high-risk peptic ulcer bleeding.The platelet count(PLT)and the albumin level(ALB)in the rebleeding subgroup were lower than non-rebleeding subgroup(P<0.05).Conclusion The incidence of peptic ulcer bleeding in men was higher than women,and the incidence of peptic ulcer bleeding of gastric ulcer was higher than duodenal ulcer in Tibet.HGB and BUN level at admission were the independent influencing factors of high-risk peptic ulcer bleeding.PLT and ALB level at admission might be the risk factors of high-risk peptic ulcer rebleeding.