出血性消化性溃疡的结局：一项前瞻性研究。

Outcomes of bleeding peptic ulcers: a prospective study.

作者信息

Liu Nai-Jen, Lee Ching-Song, Tang Jui-Hsiang, Cheng Hao-Tsai, Chu Yin-Yi, Sung Kai-Feng, Lin Cheng-Hui, Tsou Yung-Kuan, Lien Jau-Min, Chen Pang-Chi, Chiu Cheng-Tang, Cheng Chi-Liang

机构信息

Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Taipei, Taiwan.

出版信息

J Gastroenterol Hepatol. 2008 Aug;23(8 Pt 2):e340-7. doi: 10.1111/j.1440-1746.2007.05179.x. Epub 2007 Oct 17.

DOI:10.1111/j.1440-1746.2007.05179.x

PMID:17944885

Abstract

BACKGROUND AND AIM

Bleeding peptic ulcers can be due to Helicobacter pylori (H. pylori) infection, use of non-steroidal anti-inflammatory drugs (NSAIDs), or idiopathic causes. The aim of this prospective study was to identify the clinical outcomes of bleeding peptic ulcers related to different causes.

METHODS

A total of 390 patients with bleeding ulcers were evaluated consecutively between June 2005 and August 2006. The diagnosis of H. pylori infection was made at index endoscopy, using histology and the rapid urease test. If both endoscopic diagnostic tests were not performed, a serological test was applied to detect the presence of H. pylori infection in a previously untreated patient. The prevalence and outcome of bleeding ulcers are related to H. pylori infection, NSAID use, and non-H. pylori idiopathic causes. The outcome between patients who were admitted for ulcer bleeding (outpatient bleeder) and those who bled while hospitalized (in-hospital bleeder) was also compared.

RESULTS

NSAID ulcers were noted in 223 patients, H. pylori ulcers in 102, and non-H. pylori idiopathic ulcers in 65. In total, 298 patients had outpatient bleeders, and 92 had in-hospital bleeders. The overall 3-day rebleeding rate was 11.8% and the mortality rate was 5.4%. Eighteen of the 21 mortality cases died of their underlying comorbid illness. Patients with non-H. pylori idiopathic ulcers had a significantly higher mortality rate than NSAID and H. pylori ulcers (12.3% vs 4.5% vs 2.9%, P = 0.02). Patients with H. pylori ulcers had significantly favorable outcomes than patients with NSAID ulcers (less blood transfusion and a shorter hospital stay) and non-H. pylori idiopathic ulcers (shorter hospital stay and a lower mortality). Patients with in-hospital bleeders had an adverse outcome as compared to outpatient bleeders, including a 3-day rebleeding rate (25.0% vs 7.7%, P < 0.0001), 30-day rebleeding rate (32.6% vs 12.1%, P < 0.0001), and higher mortality rate (16.3% vs 2.0%, P < 0.0001).

CONCLUSION

This study emphasizes the role of non-H. pylori idiopathic ulcers and in-hospital bleeders as the determining high-risk predictors for bleeding peptic ulcers.

摘要

背景与目的

消化性溃疡出血可能由幽门螺杆菌（H. pylori）感染、使用非甾体抗炎药（NSAIDs）或特发性原因引起。本前瞻性研究的目的是确定不同原因所致消化性溃疡出血的临床结局。

方法

2005年6月至2006年8月期间，对390例溃疡出血患者进行了连续评估。在初次内镜检查时，采用组织学检查和快速尿素酶试验诊断H. pylori感染。如果未进行这两种内镜诊断试验，则对既往未治疗的患者应用血清学试验检测H. pylori感染情况。溃疡出血的患病率和结局与H. pylori感染、NSAID使用及非H. pylori特发性原因相关。同时比较了因溃疡出血入院的患者（门诊出血者）和住院期间出血的患者（院内出血者）的结局。

结果

223例患者为NSAID溃疡，102例为H. pylori溃疡，65例为非H. pylori特发性溃疡。共有298例患者为门诊出血者，92例为院内出血者。总体3天再出血率为11.8%，死亡率为5.4%。21例死亡病例中有18例死于基础合并症。非H. pylori特发性溃疡患者的死亡率显著高于NSAID溃疡和H. pylori溃疡患者（12.3%对4.5%对2.9%，P = 0.02）。H. pylori溃疡患者的结局显著优于NSAID溃疡患者（输血较少且住院时间较短）和非H. pylori特发性溃疡患者（住院时间较短且死亡率较低）。与门诊出血者相比，院内出血者的结局较差，包括3天再出血率（25.0%对7.7%，P < 0.0001）、30天再出血率（32.6%对12.1%，P < 0.0001）以及较高的死亡率（16.3%对2.0%，P < 0.0001）。