Analysis of risk factors for delayed healing of peptic ulcer in patients with upper gastrointestinal bleeding

doi:10.16150/j.1671-2870.2022.03.004

Abstract

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

CLC Number:

R573.1

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.

Figures/Tables 2

References 16

[1]	Abougergi MS, Travis AC, Saltzman JR. The in-hospital mortality rate for upper GI hemorrhage has decreased over 2 decades in the United States: a nationwide analysis[J]. Gastrointest Endosc, 2015, 81(4):882-888,e1. doi: 10.1016/j.gie.2014.09.027 pmid: 25484324
[2]	王立军. 急性上消化道出血的诊断与治疗新进展[J]. 中国中西医结合急救杂志, 2021, 28(1):125-127.
	Wang LJ. New progress in diagnosis and treatment of acute upper gastrointestinal hemorrhage[J]. Chin J Integr Tradit West Med Intensive Crit Care, 2021, 28(1):125-127.
[3]	Wilkins T, Wheeler B, Carpenter M. Upper gastrointestinal bleeding in adults: evaluation and management[J]. Am Fam Physician, 2020, 101(5):294-300. pmid: 32109037
[4]	沈雯雯, 张玫, 和芳. 北京部分地区10年中青年和老年上消化道出血病因流行病学分析及经济负担研究[J]. 中国临床医生杂志, 2018, 46(12):1402-1406.
	Shen WW, Zhang M, He F. Epidemlological analysis and economic burden of upper gastrointestinal bleeding in young and old aged patients in 10 years in Beijing[J]. Chin J Clin, 2018, 46(12):1402-1406.
[5]	Gralnek IM, Stanley AJ, Morris AJ, et al. Endoscopic dia-gnosis and management of nonvariceal upper gastrointestinal hemorrhage (NVUGIH): European Society of Gastrointestinal Endoscopy (ESGE) Guideline - Update 2021[J]. Endoscopy, 2021, 53(3):300-332. doi: 10.1055/a-1369-5274 pmid: 33567467
[6]	《中华内科杂志》编辑委员会, 《中华医学杂志》编辑委员会, 《中华消化杂志》编辑委员会, 等. 急性非静脉曲张性上消化道出血诊治指南(2018年,杭州)[J]. 中华内科杂志, 2019, 58(3):173-180.
	Chinese Journal of Internal Medicine, National Medical Journal of China, Chinese Journal of Digestion, et al. Guidelines for the diagnosis and treatment of acute non-varlceal upper gastrointestinal bleeding(2018,Hangzhou)[J]. Chin J Intern Med,2019, 58(3):173-180.
[7]	Wuerth BA, Rockey DC. Changing epidemiology of upper gastrointestinal hemorrhage in the last decade: a nationwide analysis[J]. Dig Dis Sci, 2018, 63(5):1286-1293. doi: 10.1007/s10620-017-4882-6 URL
[8]	王锦萍, 崔毅, 王锦辉, 等. 上消化道出血15年临床流行病学变化趋势[J]. 中华胃肠外科杂志, 2017, 20(4):425-431.
	Wang JP, Cui Y, Wang JH, et al. Clinical epidemiological characteristics and change trend of upper gastrointestinal bleeding over the past 15 years[J]. Zhonghua Wei Chang Wai Ke Za Zhi, 2017, 20(4):425-431.
[9]	Barkun AN, Almadi M, Kuipers EJ, et al. Management of nonvariceal upper gastrointestinal bleeding: Guideline recommendations from the International Consensus Group[J]. Ann Intern Med, 2019, 171(11):805-822. doi: 10.7326/M19-1795 pmid: 31634917
[10]	甘敏, 张明静. 老年消化性溃疡出血患者发生再出血影响因素[J]. 中国老年学杂志, 2021, 41(18):3971-3974.
	Gan M, Zhang MJ. Influencing factors of rebleeding in elderly patients with peptic ulcer bleeding[J]. Chin J Gerontol, 2021, 41(18):3971-3974.
[11]	沈清燕, 赵英恒. 老年性溃疡出血的内镜特点及预后分析[J]. 现代消化及介入诊疗杂志, 2000, 5(4):58-60.
	Shen QY, Zhao YH. Influencing factors of rebleeding in elderly patients with peptic ulcer bleeding[J]. Morden Digestion Intervent, 2000, 5(4):58-60.
[12]	Shimozato A, Sasaki M, Ogasawara N, et al. Risk factors for delayed ulcer healing after endoscopic submucosal dissection of gastric neoplasms[J]. Gastrointestin Liver Dis, 2017, 26(4):363-368.
[13]	梁兴玉. 消化性溃疡的愈合质量及其影响因素[J]. 现代诊断与治疗, 2021, 32(18):2980-2982.
	Liang XY. Healing quality of peptic ulcer and its influen-cing factors[J]. Morden Digestion Intervent, 2021, 32(18):2980-2982.
[14]	邵晓娜, 沈建伟, 沈睿炜, 等. 内镜下胃黏膜剥离术后溃疡愈合影响因素分析[J]. 浙江临床医学, 2020, 22(1):49-50.
	Shao XN, Shen JW, Shen RY, et al. Analysis of influen-cing factors on ulcer healing after endoscopic gastric mucosal dissection[J]. Zhejiang Clin Med, 2020, 22(1):49-50.
[15]	王红玉, 李惠玲, 张芹玉, 等. 胸腹腔引流管拔除后切口愈合不良相关因素分析[J]. 中华护理杂志, 2014, 49(4):410-413.
	Wang HY, Li HL, Zhang QY, et al. Risk factors of poor wound healing after the removal of thoracic and abdominal cavity drainage tube[J]. Chin J Nurs, 2014, 49(4):410-413.
[16]	郑东阳, 颜丽卿, 张卓群, 等. 抗血小板聚集药物对上消化道出血患者的临床病症及影响因素分析[J]. 中国生化药物杂志, 2016, 36(9):141-143.
	Zheng DY, Yan LQ, Zhang ZQ, et al. Analysis of clinical symptoms and influencing factors of anti-platelet aggregation drugs in patients with upper gastrointestinal blee-ding[J]. Chin J Biochem Pharmaceut, 2016, 36(9):141-143.

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