Nishikawa Hiroki, Maruo Takanori, Tsumura Takehiko, Sekikawa Akira, Kanesaka Takashi, Osaki Yukio
Department of Gastroenterology and Hepatology, Osaka Red Cross Hospital, Osaka, Japan.
Acta Gastroenterol Belg. 2013 Mar;76(1):20-4.
We elucidated risk factors contributing to recurrent hemorrhage after initial improvement of colonic diverticular bleeding. 172 consecutive hospitalized patients diagnosed with colonic diverticular bleeding were analyzed. Recurrent hemorrhage after initial improvement of colonic diverticular bleeding is main outcome measure. We analyzed factors contributing to recurrent hemorrhage risk in univariate and multivariate analyses. The length of the observation period after improvement of colonic diverticular bleeding was 26.4 +/- 14.6 months (range, 1-79 months). The cumulative recurrent hemorrhage rate in all patients at 1 and 2 years was 34.8% and 41.8%, respectively. By univariate analysis, age > 70 years (P = 0.021), BMI > 25 kg/m2 (P = 0.013), the use of anticoagulant drugs (P = 0.034), the use of NSAIDs (P = 0.040), history of hypertension (P = 0.011), history of smoking (P = 0.030) and serum creatinine level > 1.5 mg/dL (P < 0.001) were found to be significant risk factors for recurrent colonic diverticular bleeding. By multivariate analysis, age > 70 years (Hazard ratio (HR), 1.905, 95% confidence interval (CI), 1.067-3.403, P = 0.029), history of hypertension (HR, 0.493, 95% CI, 0.245-0.993, P = 0.048) and serum creatinine level > 1.5 mg/dL (HR, 95% CI, 0.288-0.964, P = 0.044) were shown to be significant independent risk factors. Close observation after the initial improvement of colonic diverticular bleeding is needed, especially in elderly patients or patients with history of hypertension or renal deficiency.
我们阐明了结肠憩室出血初步改善后导致复发性出血的危险因素。对172例连续住院的诊断为结肠憩室出血的患者进行了分析。结肠憩室出血初步改善后的复发性出血是主要结局指标。我们在单因素和多因素分析中分析了导致复发性出血风险的因素。结肠憩室出血改善后的观察期为26.4±14.6个月（范围1 - 79个月）。所有患者1年和2年的累积复发性出血率分别为34.8%和41.8%。单因素分析显示，年龄>70岁（P = 0.021）、体重指数>25 kg/m²（P = 0.013）、使用抗凝药物（P = 0.034）、使用非甾体抗炎药（P = 0.040）、高血压病史（P = 0.011）、吸烟史（P = 0.030）和血清肌酐水平>1.5 mg/dL（P < 0.001）是复发性结肠憩室出血的显著危险因素。多因素分析显示，年龄>70岁（风险比（HR），1.905，95%置信区间（CI），1.067 - 3.403，P = 0.029）、高血压病史（HR，0.493，95%CI，0.245 - 0.993，P = 0.048）和血清肌酐水平>1.5 mg/dL（HR，95%CI，0.288 - 0.964，P = 0.044）是显著的独立危险因素。结肠憩室出血初步改善后需要密切观察，尤其是老年患者或有高血压病史或肾功能不全的患者。
