目的 探索筛选阿司匹林一级预防潜在适用者的优化方法。方法 以2016年度在上海瑞金医院消化内镜中心接受麻醉胃肠镜检查的50~59岁年龄段的男性体检者为研究对象,根据胃镜、肠镜的镜下表现结合病理活检结果进行分类和匹配,录入年龄、性别、种族及民族、总胆固醇和高密度脂蛋白胆固醇水平、收缩压、糖尿病和吸烟等信息,采用心血管病（cardiovascular disease,CVD）风险评估计算器估算被研究者未来10年内发生CVD的风险,结合亚太结肠直肠筛查评分系统（Asia-Pacific Colorectal Screening Scoring System,APCS）评分,筛选适宜阿司匹林一级预防的潜在候选者。结果 在20岁以上麻醉胃肠镜体检者中,50~59岁年龄段的受检者占32.7%（1 888/5 772）,其中男性839例。胃镜检查结果提示,该年龄段男性患者中有33.5%（281/839）的体检者有胃十二指肠黏膜损伤等病变（溃疡80例,糜烂155例,癌及癌前病变、静脉曲张和术后46例,合计281例）,该部分人群可被直接排除,因为长期应用阿司匹林可能使其出血风险增加。50~59岁男性体检者中有107例（12.8%）男性体检者是阿司匹林一级预防的潜在候选者,即存在结肠直肠癌高危风险且10年内发生CVD的风险≥10%,加之其上消化道黏膜无明显病变,其中40例（4.8%）有结肠直肠腺瘤或息肉的男性吸烟者对长期预防性应用阿司匹林有较好的依从性。结论 麻醉胃肠镜体检对筛选阿司匹林一级预防潜在适用者具有优化作用,可明确消化道黏膜的基线状态,有助于降低长期阿司匹林用药的出血风险,并提高患者的依从性。
Objective: To optimize screening potential candidates for use of aspirin as primary prevention. Methods: Male subjects undergoing endoscopic examination at the endoscopic center of Shanghai Ruijin Hospital were enrolled. According to the endoscopic findings and biopsy result, upper and lower gastrointestinal (GI) lesions were classified. Information of gender, age, race, total cholesterol, HDL-cholesterol, systolic blood pressure, treatment for hypertension, status of diabetes and smoking was collected and 10-year atherosclerotic cardiovascular disease (ASCVD) risk estimation was calculated by the ASCVD Estimator. Results: A total of 5 772 subjects underwent endoscopy under light anesthesia, and 32.7% (1 885) of them were aged 50-59 years, and 839 were male. Endoscopic upper GI mucosal lesions were observed in 33.5% (281/839), and these subjects should be directly excluded because long-term use of aspirin might increase the risk of GI bleeding. One hundred and seven (12.8%) subjects who had high risk of colorectal cancer, 10-year ASCVD risk≥; 10% and had no obvious lesions in upper GI mucosa were the potential candidates for use of aspirin as primary prevention. Among them, 40 male smokers (25.2%) aged 50-59 years with colorectal adenoma or polyps might have better compliance for long-term prophylactic use of aspirin. Conclusions: Endoscopic examination under light anesthesia has optimization effects on screening potential candidates for use of aspirin as primary prevention,with which the risk of GI bleeding induced by long-term use of aspirin might be reduced, and the compliance might be improved because of the understanding of baseline status of GI mucosa.
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