CAJ | 학술논문

目的探讨冠心病患者接受肠溶阿司匹林和氯吡格雷双联抗血小板治疗过程中上消化道出血的发生率及其相关影响因素.方法选择391例联用肠溶阿司匹林和氯吡格雷的冠心病患者(双抗组)为研究对象,以502例单用肠溶阿司匹林或氯吡格雷的冠心病患者(单抗组)为对照,回顾性总结两组患者住院期间出现上消化道出血情况,比较两组之间的差异并分析其影响因素.采用SAS9.0软件进行x2检验和Logistic回归分析.结果双抗组患者上消化道出血发生率明显高于单抗组(7.1％vs.3.4％,P＜0.01).双联抗血小板治疗、年龄≥65岁、服药时间≥3月、既往有消化道病史是冠心病患者上消化道出血的危险因素(P＜0.05).联用PPIs或胃黏膜保护剂后,上消化道出血的风险显著降低(OR:0.415,95％ CI0.226～0.762,P=0.0035).结论双联抗血小板治疗明显增加上消化道出血的风险.患者高龄、长时间服药、既往消化道病史是上消化道出血的促进因素,应用PPIs或胃黏膜保护剂可有效降低上消化道出血的发生率.
목적 탐토관심병환자접수장용아사필림화록필격뢰쌍련항혈소판치료과정중상소화도출혈적발생솔급기상관영향인소.방법 선택391례련용장용아사필림화록필격뢰적관심병환자(쌍항조)위연구대상,이502례단용장용아사필림혹록필격뢰적관심병환자(단항조)위대조,회고성총결량조환자주원기간출현상소화도출혈정황,비교량조지간적차이병분석기영향인소.채용SAS9.0연건진행x2검험화Logistic회귀분석.결과 쌍항조환자상소화도출혈발생솔명현고우단항조(7.1％vs.3.4％,P＜0.01).쌍련항혈소판치료、년령≥65세、복약시간≥3월、기왕유소화도병사시관심병환자상소화도출혈적위험인소(P＜0.05).련용PPIs혹위점막보호제후,상소화도출혈적풍험현저강저(OR:0.415,95％ CI0.226～0.762,P=0.0035).결론 쌍련항혈소판치료명현증가상소화도출혈적풍험.환자고령、장시간복약、기왕소화도병사시상소화도출혈적촉진인소,응용PPIs혹위점막보호제가유효강저상소화도출혈적발생솔.
Objective To investigate the incidence and relevant factors of upper gastrointestinal bleeding(UGB)in patients with coronary heart disease(CHD)undergoing dual antiplatelet therapy(DAT)with aspirin plus clopidogrel.Methods A total of 391 CHD patients treated with aspirin plus clopidogrel (DAT group)and 502 control CHD patients receiving single antiplatelet therapy(SAT)with aspirin or clopidogrel(SAT group)were enrolled.The incidence and relevant factors associated with UGB were retrospectively analyzed in both groups of patients.Data were analyzed with Chi-square test and logistic regression by using SAS software version 9.0.Results The incidence of UGB in DAT group was significantly higher compared with SAT group(7.1％ vs.3.4％,P ＜ 0.01).The factors,including DAT,age over 65 years,medication duration over 3 months and previous digestive diseases increased the risk of UGB in CHD patients(P ＜ 0.05),while the use of PPIs(proton-pump inhibitors)or gastric mucosal protectives lowered the risk of UGB(OR:0.415,95％ CI 0.226 ～ 0.762,P =0.0035).Conclusions DAT can significantly increase the risk of UGB.UGB can be increased in elderly CHD patients and those with long-term medication and previous digestive diseases.Utility of PPIs or gastric mucosal protectives can effectively lower the incidence of UGB.