Jehangir Asad, Pathak Ranjan, Ukaigwe Anene, Donato Anthony A
Department of Internal Medicine, Reading Health System, West Reading.
Department of Hematology and Oncology, Yale University School of Medicine, New Haven, Connecticut.
Eur J Gastroenterol Hepatol. 2018 Apr;30(4):438-441. doi: 10.1097/MEG.0000000000001068.
Since the description of a correlation between aortic stenosis and angioectasia, controversy has persisted about whether these diseases are truly associated or coincidental findings of older age. Our objective was to determine the association of aortic valve disease and bleeding intestinal angioectasia from a large database.
We used the 2011 Nationwide Inpatient Sample database to identify hospitalizations in the USA in patients with bleeding intestinal angioectasia. International Classification of Diseases, 9th revision, Clinical Modification codes were used to identify patients with aortic valve disease, mitral valve disease, and known risk factors for angioectasia (including diagnosed von Willebrand disease, left ventricular assist device, and chronic kidney disease). Univariate and multivariate logistic regression were used to determine the odds of association between the valvular diseases and angioectasia.
A total of 32 079 intestinal angioectasia-related hospitalizations were identified of which 7.02% (n=2253) cases had coexistent aortic valve disease. The unadjusted odds of aortic valve disease in association with bleeding intestinal angioectasia versus those without bleeding angioectasia was 4.95 [95% confidence interval: (CI): 4.43-5.54, P<0.001]. The association of intestinal angioectasia with mitral valve disease was not significant (odds ratio=1.56, 95% CI: 0.59-4.14, P=0.38). When adjusted for age and known risk factors, the odds of aortic valve disease in bleeding intestinal angioectasia was still significant (odds ratio=2.37, 95% CI: 2.10-2.66, P<0.001).
Our findings support an important association between aortic valve disease and bleeding intestinal angioectasia, not identified in valvular heart valvular diseases with lower shear stress (mitral valve disease).
自从描述了主动脉瓣狭窄与血管扩张之间的相关性以来，对于这些疾病是真正相关还是老年患者的偶然发现一直存在争议。我们的目的是从一个大型数据库中确定主动脉瓣疾病与出血性肠道血管扩张之间的关联。
我们使用2011年全国住院患者样本数据库来识别美国出血性肠道血管扩张患者的住院情况。使用国际疾病分类第9版临床修订版代码来识别患有主动脉瓣疾病、二尖瓣疾病以及血管扩张已知危险因素（包括确诊的血管性血友病、左心室辅助装置和慢性肾脏病）的患者。采用单因素和多因素逻辑回归来确定瓣膜疾病与血管扩张之间的关联几率。
共识别出32079例与肠道血管扩张相关的住院病例，其中7.02%（n = 2253）的病例同时患有主动脉瓣疾病。与无出血性血管扩张的患者相比，伴有出血性肠道血管扩张的患者患主动脉瓣疾病的未调整几率为4.95 [95%置信区间：(CI)：4.43 - 5.54，P < 0.001]。肠道血管扩张与二尖瓣疾病之间的关联不显著（比值比 = 1.56，95% CI：0.59 - 4.14，P = 0.38）。在对年龄和已知危险因素进行调整后，出血性肠道血管扩张患者患主动脉瓣疾病的几率仍然显著（比值比 = 2.37，95% CI：2.10 - 2.66，P < 0.001）。
我们的研究结果支持主动脉瓣疾病与出血性肠道血管扩张之间存在重要关联，而在剪切应力较低的心脏瓣膜疾病（二尖瓣疾病）中未发现这种关联。
