幽门螺杆菌感染、非甾体抗炎药、低剂量阿司匹林及抗高血压药物相关的消化性溃疡出血风险：一项病例对照研究
Risk of peptic ulcer bleeding associated with Helicobacter pylori infection, nonsteroidal anti-inflammatory drugs, low-dose aspirin, and antihypertensive drugs: a case-control study.
作者信息
Nagata Naoyoshi, Niikura Ryota, Sekine Katsunori, Sakurai Toshiyuki, Shimbo Takuro, Kishida Yoshihiro, Tanaka Shohei, Aoki Tomonori, Okubo Hidetaka, Watanabe Kazuhiro, Yokoi Chizu, Akiyama Junichi, Yanase Mikio, Mizokami Masashi, Uemura Naomi
机构信息
Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Tokyo, Japan.
出版信息
J Gastroenterol Hepatol. 2015 Feb;30(2):292-8. doi: 10.1111/jgh.12805.
BACKGROUND AND AIM
The associations between antithrombotic or antihypertensive drugs and peptic ulcer bleeding (PUB) remain unknown, particularly in Asia, where Helicobacter pylori infection is prevalent. This study aims to evaluate the risks of PUB from antithrombotic drugs, angiotensin II receptor blockers (ARBs), angiotensin-converting enzyme (ACE) inhibitors, calcium channel blockers, α-blockers, and β-blockers.
METHODS
This prospective hospital-based case-control study included 230 patients with endoscopically verified PUB and 920 age and sex-matched controls (1:4) without bleeding on screening endoscopy. Adjusted odds ratios (AOR) for the risk of PUB were determined by conditional logistic regression analysis.
RESULTS
In multivariate analysis, alcohol consumption (AOR, 2.2; P < 0.001), history of peptic ulcer (AOR, 4.8; P < 0.001), H. pylori infection (AOR, 2.1; P < 0.001), comorbidity index (AOR, 1.1; P = 0.089), nonsteroidal anti-inflammatory drugs (NSAIDs) (AOR, 2.0; P = 0.025), and low-dose aspirin (AOR, 2.8; P = 0.003) increased the risk of PUB, whereas H. pylori eradication (AOR, 0.03; P < 0.001), proton pump inhibitors (PPIs) (AOR, 0.1; P < 0.001), and histamine 2-receptor antagonists (H2RA) (AOR, 0.1; P < 0.001) reduced it. No significant interactions were observed between H. pylori infection and NSAIDs use for PUB (P = 0.913). ARBs (P = 0.564), ACE inhibitors (P = 0.213), calcium channel blockers (P = 0.215), α-blockers (P = 0.810), and β-blockers (P = 0.864) were not associated with PUB.
CONCLUSION
We found that alcohol consumption, history of peptic ulcer, H. pylori infection, NSAIDs use, and low-dose aspirin use were independent risk factors for PUB, whereas H. pylori-eradication, PPIs use, and H2RA use reduced its risk. Interactions between H. pylori and NSAIDs use in PUB were not observed. No antihypertensive drug was associated with PUB.
背景与目的
抗血栓药物或抗高血压药物与消化性溃疡出血（PUB）之间的关联尚不清楚，尤其是在幽门螺杆菌感染普遍的亚洲地区。本研究旨在评估抗血栓药物、血管紧张素II受体阻滞剂（ARB）、血管紧张素转换酶（ACE）抑制剂、钙通道阻滞剂、α受体阻滞剂和β受体阻滞剂引发PUB的风险。
方法
这项基于医院的前瞻性病例对照研究纳入了230例经内镜证实为PUB的患者以及920例年龄和性别匹配的对照者（1:4），后者在筛查内镜检查时未出现出血情况。通过条件逻辑回归分析确定PUB风险的调整比值比（AOR）。
结果
在多变量分析中，饮酒（AOR，2.2；P < 0.001）、消化性溃疡病史（AOR，4.8；P < 0.001）、幽门螺杆菌感染（AOR，2.1；P < 0.001）、合并症指数（AOR，1.1；P = 0.089）、非甾体抗炎药（NSAIDs）（AOR，2.0；P = 0.025）和低剂量阿司匹林（AOR，2.8；P = 0.003）会增加PUB的风险，而根除幽门螺杆菌（AOR，0.03；P < 0.001）、质子泵抑制剂（PPI）（AOR，0.1；P < 0.001）和组胺2受体拮抗剂（H2RA）（AOR，0.1；P < 0.001）则会降低其风险。未观察到幽门螺杆菌感染与使用NSAIDs在引发PUB方面存在显著相互作用（P = 0.913）。ARB（P = 0.564）、ACE抑制剂（P = 0.213）、钙通道阻滞剂（P = 0.215）、α受体阻滞剂（P = 0.810）和β受体阻滞剂（P = 0.864）与PUB无关。
结论
我们发现饮酒、消化性溃疡病史、幽门螺杆菌感染、使用NSAIDs和低剂量阿司匹林是PUB的独立危险因素，而根除幽门螺杆菌、使用PPI和使用H2RA可降低其风险。未观察到幽门螺杆菌与使用NSAIDs在PUB方面存在相互作用。没有抗高血压药物与PUB相关。
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