血液透析增加下消化道出血和血管发育异常出血的风险：一项全国性人群研究。
Hemodialysis Increases the Risk of Lower Gastrointestinal Bleeding and Angiodysplasia Bleeding: A Nationwide Population Study.
作者信息
Tsai Tzung-Jiun, Chen Wen-Chi, Huang Yu-Tung, Yang Yi-Hsin, Feng I-Che, Wu Wen-Chieh, Hu Huang-Ming, Wu Deng-Chyang, Hsu Ping-I
机构信息
Division of Gastroenterology and Hepatology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.
National Yang-Ming University, Taipei, Taiwan.
出版信息
Gastroenterol Res Pract. 2020 Mar 3;2020:7206171. doi: 10.1155/2020/7206171. eCollection 2020.
BACKGROUND
Patients with chronic kidney disease (CKD) with or without hemodialysis were considered to have bleeding tendency and higher risk for gastrointestinal (GI) bleeding. Previous studies had documented that hemodialysis may increase the gastroduodenal ulcer bleeding. Few studies evaluated the relationship between CKD and lower GI bleeding. . An observational cohort study design was conducted. The end-stage renal disease (ESRD) patients receiving regular hemodialysis (dialysis CKD), CKD patients without dialysis (dialysis-free CKD), and controls were selected from 1 million randomly sampled subjects in the National Health Insurance Research Database of Taiwan. These three group subjects were matched by age, sex, comorbidity, and enrollment time in a 1 : 2 : 2 ratio. The Cox proportional hazard regression models were used to identify the potential risk factors for lower gastrointestinal bleeding.
RESULTS
Dialysis CKD patients ( = 574) had a higher incidence of lower GI bleeding than dialysis-free CKD patients ( = 574) had a higher incidence of lower GI bleeding than dialysis-free CKD patients ( = 574) had a higher incidence of lower GI bleeding than dialysis-free CKD patients ( < 0.001). Multivariate analysis showed that extreme old age (age ≥ 85), male gender, dialysis-free CKD, and dialysis CKD were independent factors of lower GI bleeding. Additionally, dialysis CKD patients also had a higher incidence of angiodysplasia bleeding compared to dialysis-free CKD patients and control subjects (1.1% vs. 0.1% and 0.1%, respectively; both < 0.001). Multivariate analysis showed that extreme old age (age ≥ 85), male gender, dialysis-free CKD, and dialysis CKD were independent factors of lower GI bleeding. Additionally, dialysis CKD patients also had a higher incidence of angiodysplasia bleeding compared to dialysis-free CKD patients and control subjects (1.1% vs. 0.1% and 0.1%, respectively; both.
CONCLUSION
Hemodialysis may have higher risk of lower GI bleeding and angiodysplasia bleeding.
背景
患有或未进行血液透析的慢性肾脏病（CKD）患者被认为有出血倾向且发生胃肠道（GI）出血的风险更高。既往研究表明血液透析可能增加胃十二指肠溃疡出血。很少有研究评估CKD与下消化道出血之间的关系。本研究采用观察性队列研究设计。从台湾全民健康保险研究数据库中100万随机抽样对象中选取接受定期血液透析的终末期肾病（ESRD）患者（透析CKD）、未透析的CKD患者（非透析CKD）及对照组。这三组对象按年龄、性别、合并症及入组时间以1∶2∶2的比例进行匹配。采用Cox比例风险回归模型确定下消化道出血的潜在危险因素。
结果
透析CKD患者（n = 574）下消化道出血发生率高于非透析CKD患者（n = 574），差异有统计学意义（P < 0.001）。多因素分析显示，高龄（年龄≥85岁）、男性、非透析CKD及透析CKD是下消化道出血的独立危险因素。此外，与非透析CKD患者及对照组相比，透析CKD患者血管发育异常出血的发生率也更高（分别为1.1%、0.1%和0.1%；P均< 0.001）。多因素分析显示，高龄（年龄≥85岁）、男性、非透析CKD及透析CKD是下消化道出血的独立危险因素。此外，与非透析CKD患者及对照组相比，透析CKD患者血管发育异常出血的发生率也更高（分别为1.1%、0.1%和0.1%；两者……
结论
血液透析可能有更高的下消化道出血及血管发育异常出血风险。
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