Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
Department of Medicine, National Yang-Ming University, School of Medicine, Taipei, Taiwan; Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
J Formos Med Assoc. 2019 May;118(5):939-944. doi: 10.1016/j.jfma.2018.10.007. Epub 2018 Oct 23.
BACKGROUND/PURPOSE: We aimed to identify the risk factors of first-time occurrence of non-variceal upper gastrointestinal bleeding (UGIB) among aspirin users after adjusting for confounding factors like age, gender, underlying co-morbidities, and medications.
Using the National Health Insurance Research Database of Taiwan and matching age, gender, underlying co-morbidities and enrollment time by propensity score, 11105 aspirin users and 11105 controls were identified for comparison from a cohort dataset of 1,000,000 randomly sampled subjects. Cox proportional hazard regression models were used to identify independent risk factors for first-time occurrence of non-variceal UGIB in the study cohort and in the aspirin users after adjusting for age, gender, underlying co-morbidities, and medications (e.g., non-steroidal anti-inflammatory drugs [NSAIDs], cyclooxygenase-2 [COX-2] inhibitors, steroids, thienopyridines, selective serotonin reuptake inhibitors, warfarin, and dipyridamole).
By Cox proportional hazard regression analysis, aspirin use increased the risk of first-time occurrence of UGIB (hazard ratio [HR]: 1.48; 95% confidence interval [CI]: 1.28-1.72). Age, male gender, Helicobacter pylori (H. pylori)infection, diabetes, chronic kidney disease (CKD), cirrhosis, history of uncomplicated peptic ulcer disease (PUD), and use of NSAIDs, COX-2 inhibitors, steroids, and thienopyridines were independent risk factors for UGIB among aspirin users.
In addition to age, male gender, H. pylori infection, and concomitant use of NSAIDs, COX-2 inhibitors, steroids, and thienopyridines, underlying co-morbidities including diabetes, CKD, cirrhosis, history of PUD are also important risk factors for first-time occurrence of non-variceal UGIB in aspirin users.
背景/目的：本研究旨在确定阿司匹林使用者中非静脉曲张性上消化道出血（UGIB）首次发作的风险因素，并对年龄、性别、潜在合并症和药物等混杂因素进行调整。
利用台湾全民健康保险研究数据库，通过倾向评分匹配年龄、性别、潜在合并症和入组时间，从 100 万随机抽样对象的队列数据集中确定 11105 例阿司匹林使用者和 11105 例对照者进行比较。采用 Cox 比例风险回归模型，在研究队列和阿司匹林使用者中识别非静脉曲张性 UGIB 首次发作的独立风险因素，并对年龄、性别、潜在合并症和药物（如非甾体抗炎药[NSAIDs]、环氧化酶-2[COX-2]抑制剂、类固醇、噻吩吡啶、选择性 5-羟色胺再摄取抑制剂、华法林和双嘧达莫）进行调整。
通过 Cox 比例风险回归分析，阿司匹林的使用增加了 UGIB 首次发作的风险（风险比[HR]：1.48；95%置信区间[CI]：1.28-1.72）。年龄、男性、幽门螺杆菌（H. pylori）感染、糖尿病、慢性肾脏病（CKD）、肝硬化、无并发症消化性溃疡病史以及 NSAIDs、COX-2 抑制剂、类固醇和噻吩吡啶的使用是阿司匹林使用者发生 UGIB 的独立危险因素。
除了年龄、男性、H. pylori 感染和 NSAIDs、COX-2 抑制剂、类固醇和噻吩吡啶的同时使用外，糖尿病、CKD、肝硬化和消化性溃疡病史等潜在合并症也是阿司匹林使用者发生非静脉曲张性 UGIB 的重要危险因素。
