Lanas A, Fuentes J, Benito R, Serrano P, Bajador E, Sáinz R
Service of Gastroenterology, University Hospital Lozano Blesa, Zaragoza, Spain.
Aliment Pharmacol Ther. 2002 Apr;16(4):779-86. doi: 10.1046/j.1365-2036.2002.01230.x.
To evaluate the role of Helicobacter pylori infection and other clinical factors in the risk of upper gastrointestinal bleeding in patients taking low-dose aspirin.
A case-control study was carried out of consecutive current users of low-dose aspirin admitted because of upper gastrointestinal bleeding. Within a cohort of 695 patients with upper gastrointestinal bleeding, 98 patients had taken low-dose aspirin and no other non-steroidal anti-inflammatory drug. Controls were 147 low-dose aspirin users without upper gastrointestinal bleeding of similar age, sex and extent of aspirin use as cases. H. pylori infection was determined by CagA/VacA serology and 13C-urea breath test in all cases and controls. Adjusted odds ratios (OR) are provided.
H. pylori infection was identified as an independent risk factor of upper gastrointestinal bleeding in this population (OR, 4.7; 95% confidence interval (95% CI), 2.0-10.9), but the presence of CagA-positive serology was not. Other risk factors identified were a previous ulcer history (OR, 15.2; 95% CI, 3.8-60.1), alcohol use (OR, 4.2; 95% CI, 1.7-10.4) and use of calcium channel blockers (OR, 2.54; 95% CI, 1.25-5.14). Antisecretory therapy (OR, 0.1; 95% CI, 0.02-0.3) and nitrovasodilators (OR, 0.2; 95% CI, 0.1-0.6) decreased the risk of bleeding.
H. pylori infection is a risk factor for upper gastrointestinal bleeding in low-dose aspirin users, which might have therapeutic implications in high-risk patients.
评估幽门螺杆菌感染及其他临床因素在服用低剂量阿司匹林患者发生上消化道出血风险中的作用。
对因上消化道出血入院的连续低剂量阿司匹林现用者进行病例对照研究。在695例上消化道出血患者队列中，98例服用低剂量阿司匹林且未服用其他非甾体抗炎药。对照组为147例未发生上消化道出血的低剂量阿司匹林使用者，其年龄、性别及阿司匹林使用程度与病例相似。所有病例和对照均通过CagA/VacA血清学检测和13C-尿素呼气试验确定幽门螺杆菌感染情况。提供调整后的比值比（OR）。
幽门螺杆菌感染被确定为该人群上消化道出血的独立危险因素（OR为4.7；95%置信区间（95%CI）为2.0 - 10.9），但CagA阳性血清学检测结果并非独立危险因素。其他确定的危险因素包括既往溃疡病史（OR为15.2；95%CI为3.8 - 60.1）、饮酒（OR为4.2；95%CI为1.7 - 10.4）以及使用钙通道阻滞剂（OR为2.54；95%CI为1.25 - 5.14）。抗分泌治疗（OR为0.1；95%CI为0.
