幽门螺杆菌感染和长期服用阿司匹林与上消化道出血关系研究

目的:探讨幽门螺杆菌(Hp)感染患者长期服用阿司匹林与上消化道出血的关系。方法:选取门诊每日服用100mg阿司匹林的患者,进行胃镜检查并检测Hp。根据Hp检测结果将3809例入选对象分为Hp阳性组和Hp阴性组,随访2年,观察上消化道出血情况;Hp阳性伴上消化道出血患者抗Hp治疗根除Hp后分组,分别给予法莫替丁40mg睡前顿服(干预组),或不加干预者作为对照组,2组均继续服用阿司匹林,随访2年,观察其再出血情况。结果:60岁以上老年患者服用小剂量阿司匹林上消化道出血率明显高于60岁以下患者(P<0.05);Hp阳性组2802例患者中上消化道出血146例(5.21%),Hp阴性组共1007例患者,上消化道出血为30例(2.98%),2组相比差异有统计学意义(P<0.05);144例患者根除Hp法莫替丁干预组72例,上消化道再出血2例(2.78%),对照组72例,上消化道再出血8例(11.1%),2组相比差异有统计学意义(P<0.05)。结论:60岁以上老年患者服用小剂量阿司匹林增加上消化道出血风险;Hp感染并长期服用小剂量阿司匹林可增加患者上消化道出血风险;法莫替丁干预能有效降低长期服用小剂量阿司匹林患者上消化道再出血风险。

Study on the relationship between Helicobacter priori infection with long-term use of aspirin and upper gastrointestinal bleeding

Objective To investigate the relationship between Helicobacter pylori （Hp） infection with long term use of aspirin and upper gastrointestinal bleeding. Methods Out-patients with long term use of aspirin 100 mg/d were given endoscopy and Hp testing; patients with peptic ulcer, acute gastric mucosal lesion, gastric cancer, gastric esophageal varices were excluded. Of the 3 809 cases enrolled, 2 802 cases were Hp-positive and 1 007 were Hp-negative. Patients were followed up for 2 years, and upper gastrointestinal bleeding was observed, tip was eradicated by anti-Hp therapy in 144 Hp-positive patients with upper gastrointestinal bleeding, and these patients were randomly divided into two groups, 72 patients were treated with famotidine 40 mg before going to bed and the remaining 72 patients did not receive intervention and served as control, both groups continued to take aspirin and followed 2-year to observe the occurrence of upper gastrointestinal bleeding. Results The rate of upper gastrointestinal bleeding in patients taking low-dose aspirin was significantly higher in ≥ 60 years of age group than in 〈 60 years of age group （P〈0.05）; upper gastrointestinal bleeding occurred in 146 cases （5.21%） of the Hp-positive group and in 30 cases （2.98%） of the Hp-negative group. Difference between the two groups was statistically significant （P〈0.05）. Upper gastrointestinal bleeding rate in famotidine intervention group was 2.78% （2 cases） and in control group was 11.1% （8 cases） （P〈0.05）. Conclusions Sixty years of age and older taking low-dose aspirin increased the risk of upper gastrointestinal bleeding; Hp infection and long-term use of low-dose aspirin can increase the risk of upper gastrointestinal bleeding; famotidine intervention can effectively reduce the risk of upper gastrointestinal bleeding in patients taking low dose aspirin in long term.