本文關(guān)鍵詞： 阿司匹林 胃腸粘膜損傷 胃蛋白酶原 胃泌素17 Hp感染　出處：《西南醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：背景:阿司匹林從1898年上市以來,在醫(yī)學(xué)領(lǐng)域得到廣泛的應(yīng)用,已成為目前循證醫(yī)學(xué)證據(jù)最充分及在臨床上使用范圍最廣的藥物之一,是心腦血管疾病防治的基石。低劑量阿司匹林(low dose aspirin,LDA)已成為心腦血管疾病一、二級預(yù)防最基礎(chǔ)的用藥,但由此所致的胃腸道副作用也逐漸受到重視,研究表明即便是低劑量阿司匹林即可顯著增加上消化道潰瘍出血風(fēng)險達(dá)3.7倍。盡管許多因素已被證實(shí)是阿司匹林相關(guān)胃腸粘膜損傷的高危因素,如高齡、既往消化道出血病史等,但研究發(fā)現(xiàn)在阿司匹林及非甾體類抗炎藥相關(guān)消化道出血的患者中,多達(dá)60%的患者并不屬于傳統(tǒng)的高危人群,進(jìn)一步在非高危人群中尋找新的預(yù)測因子具有重要的臨床意義。高胃酸分泌狀態(tài)和幽門螺旋桿菌(Helicobater pylori,Hp)感染是消化性潰瘍的病因,但是否也是阿司匹林相關(guān)性胃腸粘膜損傷的風(fēng)險因子仍缺乏相關(guān)研究。由于胃蛋白酶原(pepsinogen,PG)和胃泌素17(gastrin 17,G17)可以反映胃酸分泌水平,本研究擬通過探討血清PG和G17分泌水平及Hp感染狀態(tài)與阿司匹林相關(guān)性胃腸粘膜損傷的相關(guān)性,判斷可否將這些指標(biāo)用于預(yù)測阿司匹林相關(guān)胃腸粘膜損傷。目的:探討可否通過檢測血清PG,G17水平及Hp感染狀態(tài)預(yù)測阿司匹林相關(guān)胃腸粘膜損傷,為臨床醫(yī)師提供可行而有效的策略對阿司匹林相關(guān)性胃腸粘膜病變高危人群進(jìn)行識別,針對性的給予PPI一級預(yù)防。方法:長期服用低劑量阿司匹林至少1個月的患者被納入本研究;血清PGⅠ、PGⅡ及G17采用酶聯(lián)免疫法(ELISA)檢測;Hp感染檢測采取14C呼氣試驗(yàn);胃腸粘膜損傷評分參考改良LANZA胃鏡評分標(biāo)準(zhǔn)。結(jié)果:總共入選60例患者,其中15人屬于重度胃腸粘膜損傷組。在重度胃腸粘膜損傷組中PGⅠ分泌水平顯著高于輕度胃腸粘膜損傷組(156.9?39.1 VS.118.1?46.6ng/ml,P=0.04);在重度胃腸粘膜損傷組中患者Hp感染率明顯高于輕度胃腸粘膜損傷組(73%VS.40%,P=0.03);PGⅡ和G17在兩種人群中未顯示出統(tǒng)計學(xué)差異;ROC曲線提示PGⅠ的臨界值為:123ng/ml(靈敏度為80%,特異性為61.4%);Hp感染聯(lián)合PGⅠ?123ng/ml(HPGI)預(yù)測阿司匹林相關(guān)性胃腸粘膜病變風(fēng)險增高15.8倍(OR=15.8 95%CI,24?104.5)。Hp感染聯(lián)合HPGI對阿司匹林相關(guān)胃腸粘膜損害的陽性預(yù)測值為90%、陰性預(yù)測值為76%、陽性似然比為10、陰性似然比0.3、敏感性69%、特異性93%、準(zhǔn)確性81%。通過對阿司匹林所致的胃腸粘膜損傷危險因素的單因素和多因素分析發(fā)現(xiàn)性別、年齡、吸煙史、飲酒史、PG II及G17不是阿司匹林所致的胃腸損傷的獨(dú)立風(fēng)險因子,而PG I及Hp感染則是阿司匹林導(dǎo)致的胃腸損傷的獨(dú)立風(fēng)險因子(P0.05)。結(jié)論:血清PGⅠ和Hp感染可以用來識別阿司匹林相關(guān)性胃腸粘膜損傷高危人群,針對性的給予質(zhì)子泵抑制劑(proton pump inhibitor,PPI)一級預(yù)防。
[Abstract]:Background: since its launch in 1898, aspirin has been widely used in the field of medicine and has become one of the most well-documented and widely used drugs in evidence-based medicine. It is the cornerstone of cardiovascular and cerebrovascular disease prevention and treatment. Low dose aspirin dose aspirin has become the most basic drug for cardiovascular and cerebrovascular disease prevention, but the gastrointestinal side effects caused by it have been paid more and more attention. Studies have shown that even low doses of aspirin can significantly increase the risk of bleeding from upper gastrointestinal ulcers by 3.7 times, although many factors have been proven to be high risk factors for aspirin associated gastrointestinal mucosal damage, such as old age. Previous history of gastrointestinal bleeding, however, studies have found that as many as 60% of patients with gastrointestinal bleeding associated with aspirin and non-steroidal anti-inflammatory drugs do not belong to the traditional high risk group. It is of great clinical significance to find new predictors in non-high-risk population. High gastric acid secretion and Helicobater pylori infection are the etiology of peptic ulcer. However, there is still a lack of research on whether aspirin is also a risk factor for gastrointestinal mucosal injury, as pepsinogenin PGN and gastrin 17 gastrin 17 G17 can reflect gastric acid levels. The aim of this study was to investigate the relationship between serum levels of PG and G17 secretion, HP infection and aspirin associated gastrointestinal mucosal injury. Objective: to determine whether these indicators can be used to predict aspirin associated gastrointestinal mucosal injury. Objective: to explore the possibility of predicting aspirin associated gastrointestinal mucosal injury by detecting serum PGG 17 levels and HP infection status. To provide a feasible and effective strategy for clinicians to identify Aspirin-associated gastrointestinal mucosal lesions in high-risk populations. Methods: patients who had taken low-dose aspirin for at least one month were included in this study, serum PG 鈪，

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