贵州医科大学学报

2017, v.42;No.204(09) 1050-1054

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幽门螺杆菌感染对冠心病患者抗血小板治疗后上消化道出血的影响
Effect of Helicobacter Pylori Infection on Upper Gastrointestinal Hemorrhage Induced by Anti-Platelet Therapy in Patients with Coronary Heart Disease

杨湛南;方文;黄茜;
YANG Zhannan;FANG Wen;HUANG Qian;The Third Department of Cardiology,the Third Hospital of Xingtai City;School of Laboratory Science,Guizhou Medical University;Department of Gastroenterology,Xingtai People's Hospital;

摘要(Abstract):

目的:探讨幽门螺杆菌(Hp)感染与冠心病患者抗血小板药物治疗后发生上消化道出血的关系,观察根除Hp对降低此类患者上消化道出血风险的效果。方法:420例冠心病不稳定心绞痛患者,根据C-14尿素呼气试验结果分为Hp阳性组(n=270)和Hp阴性组(n=150),又将Hp阳性组分为Hp阳性治疗组(n=170)和Hp阳性未治疗组(n=100),所有患者均采用常规氯吡格雷、阿司匹林进行抗血小板治疗,Hp阳性治疗组患者采用四联用药方案进行Hp根除治疗;3组患者于治疗后1年时随访,记录上消化道出血和贫血情况、检测血肌酐、谷丙转氨酶(ALT)、血浆凝血酶原时间(PT)、血红蛋白(Hb)含量,记录再发心绞痛、非致死性心肌梗死和心力衰竭心脏不良事件发生率。结果:1年时随访结果显示,17例Hp阳性患者(6.30%)发生上消化道出血,其中Hp阳性治疗组3例(1.76%),Hp阳性未治疗组14例(14%),Hp阴性患者无上消化道出血病例,Hp阳性未治疗组患者上消化道出血发生率高于Hp阳性治疗组和Hp阴性组(P<0.05);与Hp阴性组和Hp阳性治疗组比较,Hp阳性未治疗组贫血发生率增高、Hb含量降低(P<0.05),而Hp阳性治疗组与Hp阴性组患者贫血发生率及Hb含量比较差异无统计学意义(P>0.05);3组患者PT、血肌酐及ALT水平比较,差异无统计学意义(P>0.05);3组患者治疗后1年时的随访结果显示,Hp阴性、Hp阳性治疗和未治疗患者再发心绞痛、非致死性心肌梗死及心力衰竭心脏不良事件发生率比较,差异无统计学意义(P>0.05)。结论:抗Hp治疗可降低冠心病合并Hp感染抗血小板治疗患者上消化道出血的风险,改善贫血程度。
Objective: To investigate the correlation of Helicobacter pylori( Hp) infection and upper gastrointestinal hemorrhage by anti-platelet therapy in patients with coronary heart disease,and observe the effect of Hp eradication to prophylaxis upper gastrointestinal hemorrhage. Methods: 420 patients with unstable coronary heart disease; according to14 C breath test,patients were divided into Hp positive groups( 270 cases) and Hp negative group( 150 cases); Hp positive group were further divided into Hp positive treatment group( 170 cases) and Hp positive non-treatment group( 100 cases); all patients adopted conventional clopidogrel and aspirin to carry out antiplatelet treatment,Hp positive treatment group adopted 4 combination medication therapy to eradicate Hp; 3 groups of patients were followed-up for one year,and recording UGI hemorrhage and anemia situation,testing creatinine,ALT,PT,Hb content; recording repeated angina pectoris,non-fatal myocardial infarction and heart failure adverse incidence rate. Results: 1 year follow-up visit showed that 17 Hp positive patients( 6. 30%)was found upper gastrointestinal hemorrhage in treatment group( 3 cases,1. 76%) and non-treatment group( 14,14%); Hp negative group found no cases of upper gastrointestinal hemorrhage,Hp positive untreated patients were found with higher incidence rate of upper gastrointestinal hemorrhage than Hp positive treated patients and negative group( P < 0. 05); compared with Hp negative group and Hp positive group treatment group,there was increased incidence rate of anemia and decreased Hb content in Hp positive untreated group( P < 0. 05),while anemia incidence rate and Hb content comparison of Hp positive treatment group and Hp negative group showed no statistical significance( P > 0. 05); PT,creatinine and ALT level comparison of three groups showed no statistical significance( P > 0. 05); 1year follow-up visit after treatment showed that repeated angina pectoris,non-fatal myocardial infarction and heart failure adverse incidence rate no statistical significance( P > 0. 05). Conclusion: Helicobacter pylori infection can increase the risk of upper gastrointestinal hemorrhage in coronary heart disease,and eradicating Hp therapy can reduce this risk and improve anemia degree.

关键词(KeyWords): 心脏病;冠状动脉疾病;幽门螺杆菌;出血,上消化道;C-14尿素呼气试验;阿司匹林;氯吡格雷;抗血小板治疗
heart disease;coronary artery disease;Helicobacter pylori;bleeding;upper gastrointestinal tract;14C-urea breath test;aspirin;clopidogrel;antiplatelet therapy

Abstract:

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基金项目(Foundation): 河北省卫生厅科研基金(ZD20140452)

作者(Author): 杨湛南;方文;黄茜;
YANG Zhannan;FANG Wen;HUANG Qian;The Third Department of Cardiology,the Third Hospital of Xingtai City;School of Laboratory Science,Guizhou Medical University;Department of Gastroenterology,Xingtai People's Hospital;

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DOI: 10.19367/j.cnki.1000-2707.2017.09.012

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