抗血小板治疗对老年人胃肠道损伤的临床分析

摘要

Objective To compare the risk effects of different antiplatelet therapies on gastrointestinal injury and summarize the endoscopic characteristics of gastrointestinal mucosal injury in the elderly. Methods The dyspepsia symptoms, gastrointestinal bleeding and endoscopic findings were retrospectively evaluated among 577 patients who received the antiplatelet therapy with aspirin and/or clopidogrel. Results The risk of dyspepsia symptoms and gastrointestinal bleeding was slightly higher in clopidogrel group than in aspirin group (both P＞0.05, x2=0.48, 0.72), and OR (95% CI): 1.10 (0.59-2.07) and 1.74 (0.48-6.33), for the risk of dyspepsia symptoms and gastrointestinal bleeding, respectively. In aspirin plus clopidogrel group, the risk of dyspepsia symptoms had no significant increase as compared with aspirin or clopidogrel group (x2=0.37, 0.03, for aspirin or clopidogrel group, respectively, both P＞0.05), but the risk of gastrointestinal bleeding was significantly higher than in aspirin group (x2=5.43, P＜0.05), OR (95% CI): 4.77 (1.15-19.79) and slightly higher than in clopidogrel group (P＞0.05). In this study, 57 patients received endoscopy and the detection rate of erosion or ulcer was 78.9%. Erosion (61.4%) was most in the gastric antrum; gastric ulcer (10.6%) located in gastric antrum and angle; duodenal ulcer (18.0%) located in bulb. In patients with dyspepsia symptoms erosion (70.5%), were most likely found but patients with gastrointestinal bleeding showed mainly ulcer (69.2%). Conclusions In the elderly the use of clopidogrel alone is not safer than low-dose aspirin and the combination would increase the risk of gastrointestinal bleeding. The detection rate of erosion or ulcer is high in patients with symptoms. Patients with dyspepsia symptoms most likely show erosion, but patients with gastrointestinal bleeding have mainly ulcer and complex ulcers more common.%目的 比较单用和联用抗血小板药物对老年人胃肠道损伤的风险,总结抗血小板治疗致胃肠黏膜损伤内镜特点.方法 对577例使用阿司匹林和(或)氯吡格雷的老年患者消化不良症状、消化道出血事件及内镜检查结果进行回顾性分析.结果 氯吡格雷组出现消化不良症状和消化道出血风险略高于阿司匹林组,但差异无统计学意义(x2=0.48、0.72,均P＞0.05),OR值(95%CI)分别为1.10(0.59～2.07)、1.74(0.48～6.33);阿司匹林+氯吡格雷组(联用组)有消化不良症状者较单用阿司匹林或氯吡格雷组无显著增加(x2=0.37、0.03,均P＞0.05),但消化道出血显著高于阿司匹林组(x2=5.43,P＜0.05),OR值(95%CI)4.77(1.15～19.79),略高于氯吡格雷组(P＞0.05).本组胃镜检查57例,糜烂或溃疡总检出率为45例(78.9%);糜烂多发生于胃窦部(61.4%),溃疡多发生于胃窦、胃角(10.6%)及十二指肠球部溃疡(18.0%);有消化不良症状者内镜下以糜烂为主(70.5%),消化道出血者则以溃疡为主(69.2%).结论 老年患者单用氯吡格雷发生消化不良症状及出血者,比单用小剂量阿司匹林者未见减少,阿司匹林+氯吡格雷联合使用可增加胃肠道出血的风险.抗血小板治疗有症状者内镜下糜烂或溃疡的检出率高,有消化不良症状者以糜烂为主,消化道出血者以溃疡为主,且复合溃疡多见.