上消化道出血危险因素的巢式病例对照研究

目的：评价卒中预防药物阿司匹林引发上消化道出血的用药风险。方法：采用回顾性巢式病例对照研究方法,研究293例行胃镜检查的50岁以上患者,胃纤维内窥镜确诊上消化道出血的145例纳入病例组,确诊非上消化道出血的148例纳入对照组,调查两组患者的相关信息,筛选上消化道出血的危险因素;嵌入回顾性队列研究,服用阿司匹林73例为暴露组,未曾服用阿司匹林220例为非暴露组,比较两组上消化道出血的发生情况。结果：病例对照研究表明,年龄大、吸烟嗜好、服用阿司匹林、其他非甾体抗炎药等4个因素被确认为上消化道出血独立的危险因素（阿司匹林OR值为1.802、95%CI 1.005～3.230）。队列研究表明,暴露组上消化道出血的发生率61.6%,明显高于非暴露组45.5%（P〈0.05,RR=1.354,AR=16.1%）。结论：中老年患者上消化道出血的独立危险因素有4个,服用阿司匹林是独立的危险因素,与上消化道出血的发生密切相关。建议临床选用阿司匹林时,认真权衡获益-风险比,避免使用于有胃肠黏膜基础疾病或卒中复发低度风险的患者。

Nested Case control Study on Risk Factors of Upper Gastrointestinal Bleeding

Objective:To evaluate aspirin-related medication risk and independent risk factors of upper gastrointestinal bleeding.Methods:Adopting the nested case control study to investigate 293 patients with more than 50-years-old who undergone gastroscopy at a hospital.145 patients diagnosed with upper gastrointestinal bleeding selected as the case group and another 148 patients diagnosed with non upper gastrointestinal bleeding selected as the control group.To screen the medication risk factors of upper gastrointestinal bleeding,the data of patients from the retrospective study was gone on statistical analysis.A retrospective cohort study was nested in the case control study,which 73 patients took aspirin selected as the exposure group and 220 patients did not take aspirin selected as the non-exposure group.The incidence rate of upper gastrointestinal bleeding with two groups were compared and analyzed.Results:The case control study showed that old age(elderly),smoking,aspirin taking,and NSAIDs taking were independent risk factors for upper gastrointestinal bleeding(aspirin:OR=1.802,95%CI:1.005～3.230).The cohort study analysis showed that the incidence of upper gastrointestinal bleeding in the exposure group taking aspirin in patients was 61.6%,significantly higher than the non-exposed group with incidence of 45.5%(P<0.05,RR=1.354,AR=16.1%).Conclusion:Four independent risk factors for upper gastrointestinal bleeding were selected out from hospital population of elderly patients undergone with gastroscopy.Taking aspirin is an independent risk factor,closely associated with the incidence of upper gastrointestinal bleeding.We recommend that aspirin should avoid to be used in the patients with underlying diseases of the gastrointestinal mucosa or stroke with only a low recurrence risk.