Scand J Gastroentero：上消化道出血的病因和转归

　　近日，来自冰岛和瑞典的研究者发表论文，旨在调查急性上消化道出血（AUGIB）的发病率和转归，评估药物作用与AUGIB的潜在相关性。研究指出，小剂量阿司匹林（LDA）、非甾体类抗炎药和华法林在AUGIB病原学上发挥重要作用，特别是在联合用药方面。胃溃疡和非甾体类抗炎药是严重出血的独立预测因子，以人群为基础的死亡率和住院期间需要外科手术治疗（量）低。该文发表在2013年第48卷第4期《斯堪的纳维亚胃肠病学杂志》（Scandinavian Journal of Gastroenterology）上。

　　这项前瞻性的、以人群为基础的研究，包括在2010年期间冰岛国立大学医院所有接受上消化道内镜（UGE）检查的患者。消化道出血（GIB）药物包括非甾体类抗炎药（NSAIDs）、LDA、华法林、5-羟色胺再摄取抑制剂（SSRIs）和膦酸盐，进行登记，并对冰岛所有处方药数据库进行核对。年龄与性别相匹配的对照组患者在研究期间没有消化道出血发生，并接受上消化道内镜检查。

　　共1731例患者接受了2058次上消化道内镜检查，共156例患者患有AUGIB。AUGIB粗发病率为每年 87/10万居民。最常见的病因是十二指肠溃疡（21%）和胃溃疡（15%）。LDA（40%对30%)，非甾体类抗炎药（20%对8%），华法林（15%对7%），非甾体类抗炎药＋LDA（8% 对1%）联合用药和SSRIs＋LDA（8%对3%）联合用药，上述药物在出血患者中的使用明显比非出血患者更普遍。3例患者（1.9%）采取急诊手术，2例AUGIB患者死亡。临床出血的显著独立预测因子是胃溃疡[比值比（OR）6.6，P＝0.012]和非甾体类抗炎药[比值比（OR）6.6，P＝0.004]。

与上消化道相关的拓展阅读：

• Nat Med：激光胶囊内镜或优于上消化道内镜
• 专家谈：上消化道出血诊疗中的热点问题
• 小剂量阿司匹林亦可增加上消化道出血风险 更多信息请点击：有关上消化道更多资讯

Upper gastrointestinal bleeding: incidence, etiology and outcomes in a population-based setting.
Abstract
Objective
The authors aimed to investigate the incidence and outcomes of acute upper gastrointestinal bleeding (AUGIB) and to examine the role of drugs potentially associated with AUGIB.
Methods
The study was prospective, population-based and consisted of all patients who underwent upper gastrointestinal endoscopy (UGE), during the year of 2010 at the National University Hospital of Iceland. Drug intake of NSAIDs, low-dose aspirin (LDA), warfarin, SSRIs and bisphosphonates prior to GIB was prospectively registered and also checked in a Pharmaceutical Database covering all prescriptions in Iceland. An age- and gender-matched control group consisted of patients who underwent UGE during the study period and were without GIB.
Results
A total of 1731 patients underwent 2058 UGEs. Overall, 156 patients had AUGIB. The crude incidence for AUGIB was 87/100,000 inhabitants per year. The most common etiologies were duodenal (21%) and gastric ulcers (15%). Use of LDA (40% vs. 30%), NSAIDs (20% vs. 8%), warfarin (15% vs. 7%), combination of NSAIDs + LDA (8% vs. 1%) and SSRIs + LDA (8% vs. 3%) were significantly more common among bleeders than non-bleeders. Three patients (1.9%) had emergency surgery and two patients died of AUGIB. Independent predictors of clinically significant bleeding were gastric ulcer (OR 6.6, p = 0.012) and NSAIDs (OR 6.6, p = 0.004).
Conclusions
LDA, NSAIDs and warfarin play an important role in AUGIB etiology and particularly combinations of drugs. Gastric ulcer and NSAIDs were independent predictors of severe bleeding. Mortality and the need for surgery during hospitalization was low in this population-based setting.