Department of Gastroenterology, Kaiser Permanente Medical Care Plan, San Diego, California, USA.
Clin Gastroenterol Hepatol. 2010 Jan;8(1):49-54. doi: 10.1016/j.cgh.2009.09.006. Epub 2009 Sep 16.
BACKGROUND & AIMS: Information is limited on risk factors for acute large bowel ischemia (ALBI). We investigated diseases and drugs associated with ALBI.
We compared patients hospitalized with ALBI and controls through multivariate analysis of prior outpatient/emergency department/inpatient diagnoses and pharmacy dispensing records.
There were 379 cases and 1516 controls (median age, 69 y; range, 25-97 y; 74.4% female). Disorders that were diagnosed in more cases than controls, based on univariate analysis (P < .05), included hypertension, diabetes, chronic obstructive pulmonary disease, atrial fibrillation, congestive heart failure, depression, asthma, coronary artery disease, dementia, rheumatoid arthritis, irritable bowel syndrome, dialysis dependency, diarrhea, and constipation. Drugs dispensed to more cases than controls were antihypertensives, opioids, statins, female hormones, potentially constipating drugs, histamine H(2)-antagonists, immunomodulators, digoxin, clopidogrel/ticlopidine, taxanes/vinca alkaloids, and antibiotics. In all cases, ALBI was associated independently with hypertension (adjusted odds ratio [AOR], 3.21, 95% confidence interval [CI]; 2.28-4.53; P < .0001), chronic obstructive pulmonary disease (AOR, 3.13; 95% CI, 2.06-4.75; P < .0001), diarrhea (AOR, 2.36; 95% CI, 1.13-4.89; P = .0218), atrial fibrillation (AOR, 2.21; 95% CI, 1.34-3.64; P = .0019), congestive heart failure (AOR, 1.94; 95% CI, 1.11-3.39; P = .0205), diabetes (AOR, 1.82; 95% CI, 1.31-2.53; P = .0004), antibiotics (AOR, 3.30; 95% CI, 2.19-4.96; P < .0001), opioids (AOR, 1.96; 95% CI, 1.43-2.67; P < .0001), and potentially constipating drugs (AOR, 1.75; 95% CI, 1.25-2.44; P = .0012). Analysis of only women revealed similar associations except for diarrhea plus rheumatoid arthritis (AOR, 3.27; 95% CI, 1.07-9.96; P = .0370), irritable bowel syndrome (AOR, 2.72; 95% CI, 1.04-7.14; P = .0424), and female hormones (AOR, 1.88; 95% CI, 1.30-2.73; P = .0009).
Heterogeneous diseases and drugs increase the risk of ALBI, consistent with multifactorial pathogenesis.
急性大肠缺血（ALBI）的危险因素信息有限。我们研究了与 ALBI 相关的疾病和药物。
我们通过多变量分析门诊/急诊/住院前诊断和药房配药记录，比较了住院 ALBI 患者和对照组。
共纳入 379 例 ALBI 患者和 1516 例对照组（中位年龄 69 岁；范围 25-97 岁；74.4%为女性）。根据单因素分析（P<.05），诊断为高血压、糖尿病、慢性阻塞性肺疾病、心房颤动、充血性心力衰竭、抑郁症、哮喘、冠心病、痴呆、类风湿关节炎、肠易激综合征、透析依赖、腹泻和便秘的病例多于对照组。与对照组相比，处方药物包括降压药、阿片类药物、他汀类药物、女性激素、潜在致便秘药物、组胺 H2 拮抗剂、免疫调节剂、地高辛、氯吡格雷/噻氯匹定、紫杉烷/长春碱类药物和抗生素的病例更多。在所有病例中，ALBI 与高血压（调整后比值比 [OR]，3.21；95%置信区间 [CI]，2.28-4.53；P<.0001）、慢性阻塞性肺疾病（OR，3.13；95%CI，2.06-4.75；P<.0001）、腹泻（OR，2.36；95%CI，1.13-4.89；P=0.0218）、心房颤动（OR，2.21；95%CI，1.34-3.64；P=0.0019）、充血性心力衰竭（OR，1.94；95%CI，1.11-3.39；P=0.0205）、糖尿病（OR，1.82；95%CI，1.31-2.53；P=0.0004）、抗生素（OR，3.30；95%CI，2.19-4.96；P<.0001）、阿片类药物（OR，1.96；95%CI，1.43-2.67；P<.0001）和潜在致便秘药物（OR，1.75；95%CI，1.25-2.44；P=0.0012）独立相关。仅对女性的分析显示出类似的关联，除了腹泻加类风湿关节炎（OR，3.27；95%CI，1.07-9.96；P=0.0370）、肠易激综合征（OR，2.72；95%CI，1.04-7.14；P=0.0424）和女性激素（OR，1.88；95%CI，1.30-2.73；P=0.0009）。
不同的疾病和药物增加了 ALBI 的风险，与多因素发病机制一致。
