Xu Y
Department of Gastroenterology, Peking University First Hospital, Beijing 100034, China.
Department of Gastroenterology, Tibet Autonomous Region People's Hospital, Lhasa 850000, China.
Beijing Da Xue Xue Bao Yi Xue Ban. 2022 Feb 18;54(1):161-165. doi: 10.19723/j.issn.1671-167X.2022.01.025.
To explore the relationship between high altitude polycythemia (HAPC) and peptic ulcer bleeding, in order to provide the evidence for the clinical diagnosis and treatment of peptic ulcer disease in Tibet of China.
A retrospective case-control study was conducted. Patients who hospitalized in the Department of Gastroenterology with the diagnosis of peptic ulcer bleeding from January 1, 2015 to April 30, 2021 in Tibet Autonomous Region People's Hospital were enrolled in the case group, and patients who hospitalized in the Department of Urology without tumor and without the history of peptic ulcer and gastrointestinal bleeding during the same period were selected as the control group. In the study, 1 ∶ 1 case matching was conducted between the two groups according to the gender, age (±2 years), ethnic group (Tibetan, Han), and the residence altitude level (grouped by < 4 000 m or ≥4 000 m), and 393 cases were included in the case group and the control group respectively. All the patients had lived in Tibet with the altitude >2 500 m for more than 1 year, and with age ≥ 18 years. The risk factors of peptic ulcer bleeding (place of residence, smoking, alcohol, the use of NSAIDs/anticoagulants, and combined with chronic diseases, such as HAPC, hypertension, diabetes mellitus, heart disease, hyperlipidemia, cerebrovascular disease, chronic lung disease, joint disease) were analyzed and compared between the two groups.
There were 28 (7.1%) patients with HAPC in the case group, and 5 (1.3%) in the control group. The incidence of HAPC in the case group was significantly higher than those in the control group, < 0.001, and the value was 5.953. Multivariate Logistic regression analysis showed that HAPC (=5.270, 95%: 1.806-15.380), living in cities and towns (=2.369, 95%: 1.559-3.602), alcohol (=3.238, 95%: 1.973-5.317) and the use of NSAIDs/anticoagulants (=20.584, 95%: 2.639-160.545) were the independent risk factors for peptic ulcer bleeding in Tibet. After adjusting for the possible confounding factors, such as living in cities and towns, alcohol, and the use of NSAIDs/anticoagulants, HAPC was associated with an increased risk of peptic ulcer bleeding in Tibet, and the value was 5.270.
HAPC was associated with a significantly increased risk of peptic ulcer bleeding in Tibet. Patients with HAPC and peptic ulcer should be diagnosed and treated actively, in order to avoid gastrointestinal bleeding and other serious complications.
探讨高原红细胞增多症（HAPC）与消化性溃疡出血之间的关系，为我国西藏地区消化性溃疡疾病的临床诊断与治疗提供依据。
进行一项回顾性病例对照研究。将2015年1月1日至2021年4月30日在西藏自治区人民医院消化内科住院诊断为消化性溃疡出血的患者纳入病例组，选择同期在泌尿外科住院且无肿瘤、无消化性溃疡病史及无胃肠道出血史的患者作为对照组。研究中，根据性别、年龄（±2岁）、民族（藏族、汉族）和居住海拔水平（按<4000米或≥4000米分组）对两组进行1∶1病例匹配，病例组和对照组各纳入393例。所有患者均在海拔>2500米的西藏居住1年以上，年龄≥18岁。分析并比较两组消化性溃疡出血的危险因素（居住地、吸烟、饮酒、使用非甾体抗炎药/抗凝剂以及合并慢性病，如HAPC、高血压、糖尿病、心脏病、高脂血症、脑血管疾病、慢性肺病、关节疾病）。
病例组有28例（7.1%）HAPC患者，对照组有5例（1.3%）。病例组HAPC发病率显著高于对照组，P<0.001，χ²值为5.953。多因素Logistic回归分析显示，HAPC（OR=5.270，95%CI：1.806 - 15.380）、居住在城镇（OR=2.369，95%CI：1.559 - 3.602）、饮酒（OR=3.238，95%CI：1.973 - 5.317）和使用非甾体抗炎药/抗凝剂（OR=20.584，95%CI：2.639 - 160.545）是西藏消化性溃疡出血的独立危险因素。校正居住在城镇、饮酒和使用非甾体抗炎药/抗凝剂等可能的混杂因素后，HAPC与西藏消化性溃疡出血风险增加相关，OR值为5.270。
在西藏，HAPC与消化性溃疡出血风险显著增加相关。应积极对HAPC合并消化性溃疡患者进行诊断和治疗，以避免胃肠道出血等严重并发症。
