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中华临床医师杂志(电子版) ›› 2023, Vol. 17 ›› Issue (11) : 1147 -1153. doi: 10.3877/cma.j.issn.1674-0785.2023.11.003

临床研究

281例消化性溃疡出血的临床特征
陈润祥, 张大涯, 陈世锔, 张晓冬, 黄士美, 陈晨, 李达, 曾凡, 白飞虎()   
  1. 570100 海南海口,海南医学院研究生院
    570100 海南海口,海南医学院第二附属医院消化内科;570100 海南海口,海南省器官系统疾病中心(消化疾病中心)
  • 收稿日期:2023-07-25 出版日期:2023-11-15
  • 通信作者: 白飞虎
  • 基金资助:
    海南省临床医学中心建设项目资助(2021818); 海南省院士创新平台科研项目资金资助(00817378); 海南医学院研究生创新科研课题(HYYS2021B14)

Clinical characteristics of 281 cases of peptic ulcer bleeding

Runxiang Chen, Daya Zhang, Shiju Chen, Xiaodong Zhang, Shimei Huang, Chen Chen, Da Li, Fan Zeng, Feihu Bai()   

  1. Graduate School of Hainan Medical College, Haikou 570100, China
    Department of Gastroenterology, The Second Affiliated Hospital of Hainan Medical University, Haikou 570100, China;Hainan Digestive Disease Clinical Research Center, Haikou 570100, China
  • Received:2023-07-25 Published:2023-11-15
  • Corresponding author: Feihu Bai
引用本文:

陈润祥, 张大涯, 陈世锔, 张晓冬, 黄士美, 陈晨, 李达, 曾凡, 白飞虎. 281例消化性溃疡出血的临床特征[J/OL]. 中华临床医师杂志(电子版), 2023, 17(11): 1147-1153.

Runxiang Chen, Daya Zhang, Shiju Chen, Xiaodong Zhang, Shimei Huang, Chen Chen, Da Li, Fan Zeng, Feihu Bai. Clinical characteristics of 281 cases of peptic ulcer bleeding[J/OL]. Chinese Journal of Clinicians(Electronic Edition), 2023, 17(11): 1147-1153.

目的

了解海南地区281例消化性溃疡出血的临床特征,为进一步做好当地消化性溃疡出血的防治工作提供理论依据。

方法

选取2020年12月~2022年12月因呕血或黑便就诊海南医学院第二附属医院,内镜下诊断为消化性溃疡出血患者281例。通过Forrest分级将消化性溃疡出血患者分为低危组(Ⅱc级和Ⅲ级)和高危组(Ⅰa~Ⅱb)。根据内镜止血后是否再发出血将高危组患者进一步细分为非再出血亚组和再出血亚组。收集并分析患者的一般资料和临床特征,通过多因素Logistic回归分析高危溃疡的影响因素。

结果

281例消化性溃疡出血患者,男女性别比为4.73∶1;幽门螺杆菌(Helicobacter pylori,Hp)感染率为63.7%;居住农村189例(67.3%);老年组163例(58.0%),非老年组118例(42.0%);高危组148例(52.7%),低危组 133例(47.3%);再出血亚组30例(10.7%),非再出血亚组251例(89.3%);高危溃疡患者的再出血率为18.9%。高危组患者在男性,吸烟史、饮自酿白酒史、感染Hp、溃疡直径>2 cm、再出血占比中均高于低危组,PT和尿素氮水平高于低危组(P<0.05)。Logistic回归分析结果显示饮自酿白酒(OR=3.319,P=0.001)、Hp感染(OR=2.455,P=0.001)、PT(OR=1.202,P=0.026)和溃疡直径>2 cm(OR=3.041,P=0.029)为高危消化性溃疡出血的独立危险因素。再出血亚组中溃疡直径>2 cm多于无再出血亚组。

结论

海南地区消化性溃疡出血患者中,老年患者多于非老年患者,男性多于女性。饮自酿白酒、Hp感染、PT水平和溃疡直径>2 cm是出现高危溃疡的独立危险因素。大直径溃疡是内镜治疗后再出血的主要危险因素。

Objective

To summarize the clinical characteristics of 281 cases of peptic ulcer bleeding in Hainan, in order to provide a theoretical basis for further prevention and treatment of peptic ulcer bleeding in this region.

Methods

A total of 281 patients with an endoscopic diagnosis of bleeding peptic ulcer who visited the Second Affiliated Hospital of Hainan Medical College for hematemesis and melena from December 2020 to December 2022 were selected. Patients with peptic ulcer bleeding were classified into a low-risk group (IIc and III) and a high-risk group (Ⅰa-Ⅱb) according to the endoscopic Forrest classification. Patients in the high-risk group were further subdivided into a non-rebleeding subgroup and a rebleeding subgroup according to whether rebleeding occurred after endoscopic hemostasis. General information and clinical characteristics of the patients were collected and analyzed, and factors influencing high-risk ulcers were analyzed by multivariate logistic regression.

Results

In 281 patients with bleeding peptic ulcer, the male to female ratio was 4.73∶1; the Helicobacter pylori (Hp) infection rate was 63.7%; 189 cases (67.3%) lived in rural areas; 163 cases (58.0%) were in the elderly group and 118 (42.0%) in the non-elderly group; 148 cases (52.7%) were in the high-risk group and 133 (47.3%) in the low-risk group; 30 cases (10.7%) were in the rebleeding subgroup and 251 (89.3%) in the non-rebleeding subgroup; and the rebleeding rate was 18.9% in the high-risk ulcer patients. Patients in the high-risk group were significantly more likely to be men and have smoking history, history of home-brewed liquor consumption, Hp infection, ulcer diameter >2 cm, and rebleeding than those of the low-risk group, and had higher prothrombin time (PT) and urea nitrogen levels than the low-risk group (P<0.05). Logistic regression analysis showed that drinking home-brewed liquor (odds ratio [OR]=3.319, P=0.001), Hp infection (OR=2.455, P=0.001), PT (OR=1.202, P=0.026), and ulcer diameter >2 cm (OR=3.041, P=0.029) were independent risk factors for high-risk peptic ulcer bleeding. There were more ulcers >2 cm in diameter in the rebleeding subgroup than in the non-rebleeding subgroup.

Conclusion

Among patients with bleeding peptic ulcers in Hainan, there are more elderly patients than non-elderly patients and more men than women. Drinking home-brewed white wine, Hp infection, PT, and ulcer diameter >2 cm are independent risk factors for high-risk ulcers. Large diameter ulcers may be a major risk factor for rebleeding after endoscopic treatment.

表1 不同年龄组溃疡出血患者一般资料比较[n(%)]
表2 不同溃疡出血部位患者一般资料比较
一般资料 低危组(n=133) 高危组(n=148) χ2Z P
性别[n(%)] 9.538 0.002
100(75.2) 132(89.2)
33(24.8) 16(10.8)
年龄[MP25P75),岁] 62.0(53.0,71.5) 62.0(47.5,71.0) -0.988Z 0.323
居住地[n(%)] 0.137 0.711
农村 88(66.2) 101(68.2)
城镇 45(33.8) 47(31.8)
吸烟史[n(%)] 9.217 0.002
47(35.3) 79(53.4)
86(64.7) 69(46.6)
饮自酿白酒[n(%)] 31.056 <0.001
25(18.8) 75(50.7)
108(81.2) 73(49.3)
合并慢性病[n(%)] 0.276 0.600
≥2种 48(36.1) 49(33.1)
<2种 85(63.9) 99(66.9)
Hp感染[n(%)] 15.261 <0.001
69(51.9) 110(74.3)
64(48.1) 38(25.7)
NSAIDs与抗凝药物史[n(%)] 0.137 0.711
45(33.8) 47(31.8)
88(66.2) 101(68.2)
血红蛋白[MP25P75),g/L] 85.0(85.0,100.0) 86.0(67.3,107.0) -0.085Z 0.933
血小板[MP25P75),×109/L] 235.0(196.5,292.0) 219.5(178.0,275.0) -1.929Z 0.054
尿素氮[MP25P75),mmol/L] 8.1(5.5,13.3) 10.9(7.0,14.9) -2.831Z 0.005
PT [MP25P75),s] 11.4(10.6,12.3) 11.7(10.9,13.0) -2.333Z 0.020
APTT[MP25P75),s] 26.6(23.6,29.6) 26.7(24.1,30.6) -0.973Z 0.331
溃疡直径>2 cm[n(%)] 6.761 0.009
6(4.5) 20(13.5)
127(95.5) 128(86.5)
再出血[n(%)] 22.278 <0.001
2(1.5) 28(18.9)
131(98.5) 120(81.1)
表3 消化性溃疡出血危险情况影响因素的多因素 Logistic 回归分析
表4 高危溃疡患者无再出血亚组和再出血亚组的临床特征对比
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