幽门螺杆菌感染对服用非甾体抗炎药、抗血小板药物、抗凝剂、皮质类固醇和选择性 5-羟色胺再摄取抑制剂的患者发生消化性溃疡出血的风险的影响。

Contribution of Helicobacter pylori infection to the risk of peptic ulcer bleeding in patients on nonsteroidal anti-inflammatory drugs, antiplatelet agents, anticoagulants, corticosteroids and selective serotonin reuptake inhibitors.

机构信息

Department of Gastroenterology, Hepatology and Infectious Diseases, Otto-von-Guericke University Hospital, Magdeburg, Germany.

Institute for Biometrics and Medical Informatics, Otto-von-Guericke University Hospital, Magdeburg, Germany.

出版信息

Aliment Pharmacol Ther. 2018 Jun;47(11):1464-1471. doi: 10.1111/apt.14652. Epub 2018 Apr 14.

DOI:10.1111/apt.14652

PMID:29655196

Abstract

BACKGROUND

Nonsteroidal anti-inflammatory drugs, low-dose aspirin, non-aspirin antiplatelet agents, anticoagulants, selective serotonin reuptake inhibitors and corticosteroids increase the risk of gastroduodenal bleeding.

AIM

To determine in a retrospective cohort study the contribution of Helicobacter pylori infection to the risk of peptic ulcer bleeding in patients taking these drugs.

METHODS

Among patients with peptic ulcer disease diagnosed by endoscopy from 01/2004 to 12/2014 (N = 1719, 60% males, age 65.8 ± 14.5), 56.9% had peptic ulcer bleeding (cases) and 43.1% uncomplicated peptic ulcer disease (controls). Demographics, intake of nonsteroidal anti-inflammatory drugs, aspirin, non-aspirin antiplatelet agents, anticoagulants, selective serotonin reuptake inhibitors, proton pump inhibitors and corticosteroids were documented. H. pylori status was determined by histology, rapid urease test or serology. Adjusted odds ratios (OR) were estimated by logistic regression analysis.

RESULTS

Helicobacter pylori infection increased the risk of peptic ulcer bleeding in nonsteroidal anti-inflammatory drug and aspirin users (OR = 2.91, 95% CI = 1.71-4.98 and OR = 2.23, 95% CI = 1.52-3.28, respectively), but not in patients on anticoagulants, selective serotonin reuptake inhibitor or corticosteroid therapy. H. pylori-positive status substantially increased the risk of peptic ulcer bleeding in patients on non-aspirin antiplatelet agents (OR = 4.37, 95% CI = 1.28-14.99), concomitant aspirin/nonsteroidal anti-inflammatory drug intake (OR = 5.85, 95% CI = 1.68-20.36) and combined antiplatelet therapy (OR = 8.43, 95% CI = 1.09-65.17). After further adjustment for proton pump inhibitor intake, H. pylori infection was still a risk factor for peptic ulcer bleeding in nonsteroidal anti-inflammatory drug and aspirin users.

CONCLUSIONS

Helicobacter pylori infection increases the risk of peptic ulcer bleeding in peptic ulcer disease patients on nonsteroidal anti-inflammatory drugs, aspirin and non-aspirin antiplatelet agents. H. pylori-positive patients on combined antiplatelet therapy carry the highest risk for peptic ulcer bleeding.

摘要

背景

非甾体抗炎药、低剂量阿司匹林、非阿司匹林抗血小板药物、抗凝剂、选择性 5-羟色胺再摄取抑制剂和皮质类固醇会增加胃十二指肠出血的风险。

目的

在一项回顾性队列研究中，确定幽门螺杆菌感染在服用这些药物的患者中对消化性溃疡出血风险的贡献。

方法

在 2004 年 1 月至 2014 年 12 月期间通过内镜诊断为消化性溃疡病的患者中（N=1719，60%为男性，年龄 65.8±14.5），56.9%有消化性溃疡出血（病例），43.1%为单纯消化性溃疡病（对照）。记录了人口统计学资料、非甾体抗炎药、阿司匹林、非阿司匹林抗血小板药物、抗凝剂、选择性 5-羟色胺再摄取抑制剂、质子泵抑制剂和皮质类固醇的摄入量。通过组织学、快速尿素酶试验或血清学确定幽门螺杆菌状态。通过逻辑回归分析估计调整后的比值比（OR）。

结果

幽门螺杆菌感染增加了非甾体抗炎药和阿司匹林使用者消化性溃疡出血的风险（OR=2.91，95%CI=1.71-4.98 和 OR=2.23，95%CI=1.52-3.28），但对接受抗凝剂、选择性 5-羟色胺再摄取抑制剂或皮质类固醇治疗的患者则没有影响。幽门螺杆菌阳性状态显著增加了非阿司匹林抗血小板药物患者的消化性溃疡出血风险（OR=4.37，95%CI=1.28-14.99）、同时使用阿司匹林/非甾体抗炎药（OR=5.85，95%CI=1.68-20.36）和联合抗血小板治疗（OR=8.43，95%CI=1.09-65.17）。在进一步调整质子泵抑制剂摄入后，幽门螺杆菌感染仍然是非甾体抗炎药和阿司匹林使用者消化性溃疡出血的一个危险因素。