上消化道溃疡伴出血患者溃疡愈合延迟的危险因素分析

doi:10.16150/j.1671-2870.2022.03.004

摘要/Abstract

摘要：

目的：分析上消化道出血（upper gastrointestinal bleeding,UGIB）患者上消化道溃疡愈合延迟的危险因素,为指导临床治疗提供依据。方法：回顾性分析2012年1月至2021年12月因上消化道溃疡致UGIB的住院患者138例,根据治疗1周后胃镜复查显示的溃疡愈合率,对其性别、年龄、体质量指数、糖尿病、非甾体类消炎药服用史、吸烟、饮酒、幽门螺杆菌、血红蛋白、血清白蛋白、溃疡部位、Forrest分级、溃疡大小等指标进行单因素分析,筛选出有统计学意义的指标,再行多因素Logistic回归分析。结果：本研究中上消化道溃疡愈合延迟率为39.86%。单因素分析显示,年龄、血清白蛋白、溃疡部位、Forrest分级、溃疡大小与UGIB患者溃疡愈合延迟相关（P<0.05）。多因素Logistic回归分析显示,溃疡位于胃部、Forrest分级（Ⅰa~Ⅱc）、溃疡面积≥2 cm²是UGIB患者溃疡愈合延迟的独立危险因素（P<0.05）。结论：UGIB患者的消化性溃疡位于胃部、Forrest分级Ⅰa~Ⅱc、溃疡面积≥2 cm²会增加其消化性溃疡愈合延迟的风险,针对该类高危人群应采取积极的应对措施。

关键词: 上消化道出血, 消化性溃疡, 溃疡愈合延迟, 危险因素

Abstract:

Objective: To investigate the risk factors for delayed healing of peptic ulcer in patients with upper gastrointestinal bleeding (UGIB), so as to provide evidences for clinical treatment. Methods: A total of consecutive 138 hospitalized patients with UGIB due to peptic ulcer from January 2012 to December 2021 were enrolled. The healing rate of peptic ulcer was determined under reexamination of gastroscopy after 1 week of treatment. The related indice were analyze with univariate analysis to determine possible influencing factors for peptic ulcer, including gender, age, body mass index (BMI), diabetes, history of taking steroid anti-inflammatory drugs (NSAIDS), smoking, drinking, Helicobacter pylori (Hp) infection, hemoglobin, serum albumin, ulcer location or Logistic regression analysis was performed to determine the independent risk factors. Results: Univariate analysis showed that age, levels of serum albumin, Forrest classification, the location and size of ulcers were associated with delayed healing of ulcers in patients with upper gastrointestinal bleeding (P<0.05). Multivariate Logistic regression analysis showed that Forrest classification, location and size of ulcers were independent risk factors for delayed healing of ulcers in patients with upper gastrointestinal bleeding(P<0.05). Conclusions: Forrest classification, location and size of ulcers in patients with upper gastrointestinal bleeding may delay the healing of peptic ulcer in patients with upper gastrointestinal bleeding and countermeasures should be taken to deal with the above risk factors.

Key words: Upper gastrointestinal bleeding, Peptic ulcer, Delayed ulcer healing, Risk factors

中图分类号:

R573.1

丁燕飞, 忻笑容, 周郁芬, 谢玲, 谷雷雷, 吴云林, 陈平. 上消化道溃疡伴出血患者溃疡愈合延迟的危险因素分析[J]. 诊断学理论与实践, 2022, 21(03): 312-316.

DING Yanfei, XIN Xiaorong, ZHOU Yufen, XIE Ling, GU Leilei, WU Yunlin, CHEN Ping. Analysis of risk factors for delayed healing of peptic ulcer in patients with upper gastrointestinal bleeding[J]. Journal of Diagnostics Concepts & Practice, 2022, 21(03): 312-316.

图/表 2

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表2

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指标	例数（n）	溃疡愈合率（%）	差值中位数（95%CI）	秩和检验
指标	例数（n）	溃疡愈合率（%）	差值中位数（95%CI）	统计量	P值
性别男	120	75.00（33.33,95.44）	-8（-25~0）	-1.419	0.156
女	18	87.50（40.75,100）
年龄			10（0~25）	-2.231	0.026
<60岁	79	80.00（44.44,100）
≥60岁体质量指数	59	59.18（26.53,90.4）	0（-87~9）	-0.073	0.942
<24 kg/m²	72	75.00（21.25,100）
≥24 kg/m²	66	75.00（41.67,94.31）
糖尿病			-2.5（-21.0~8.3）	-0.691	0.489
有	20	61.88（28.23,91.80）
无	118	75.00（37.50,100）
NSAIDS服用			0（-12.5~12.1）	-0.033	0.974
有	32	68.75（38.54,99.50）
无	106	75.00（33.33,100）
饮酒			-6.2（-18.8~2.2）	-1.093	0.275
有	42	62.50（26.15,92.22）
无	96	75.00（37.63,100）
吸烟			0（-20.2~0）	-0,990	0.322
有	50	66.38（19.17,100）
无	88	75.00（40.00,100）
幽门螺杆菌			0（-13.3~6）	-0.508	0.611
有	44	75.00（36.46,94.31）
无	94	75.00（34.37,100）
血清白蛋白（g/L）			-17.5（-35.6~1.4）	-2.875	0.004
≤33	49	46.67（0,90.51）
>33	89	77.78（47.08,100）
血红蛋白（g/L）			0（-7.9~15.3）	-0.504	0.614
<80	38	78.13（40.00,100）
≥80	100	72.15（34.34,100）
溃疡部位			16.7（0~31.2）	-2.662	0.008
胃	64	55.00（25.00,89.47）
十二指肠球部	74	83.33（48.61,100）
溃疡面积（cm²）			22.2（4.4~46.7）	-2.757	0.006
<2	111	75.00（41.67,100）
≥2	27	30.56（0,91.67）
Forrest分级			-15.8（-31.2~0）	-2.663	0.008
Ⅰa~Ⅱc	55	50.00（0,91.67）
Ⅲ	83	79.17（44.44,100）

指标	B	Wald值	OR值（95%CI）	P值
年龄≥60岁	-0.490	1.490	0.613（0.279~1.346）	0.222
血清白蛋白<33 g/L	0.132	0.095	1.141（0.493~2.639）	0.758
溃疡部位（胃）	0.965	5.422	2.624（1.165~5.910）	0.020
溃疡面积≥2 cm²	-0.985	4.060	0.373（0.143~0.974）	0.044
Forrest分级Ⅰa~Ⅱc	0.798	4.071	2.222（1.023~4.824）	0.044