胃相关血浆生物标记物对低剂量阿司匹林相关胃肠粘膜病变预测价值的研究

发布时间：2018-02-11 21:59

  本文关键词： 阿司匹林 胃肠粘膜损伤 胃蛋白酶原 胃泌素17 Hp感染　出处：《西南医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：背景:阿司匹林从1898年上市以来,在医学领域得到广泛的应用,已成为目前循证医学证据最充分及在临床上使用范围最广的药物之一,是心脑血管疾病防治的基石。低剂量阿司匹林(low dose aspirin,LDA)已成为心脑血管疾病一、二级预防最基础的用药,但由此所致的胃肠道副作用也逐渐受到重视,研究表明即便是低剂量阿司匹林即可显著增加上消化道溃疡出血风险达3.7倍。尽管许多因素已被证实是阿司匹林相关胃肠粘膜损伤的高危因素,如高龄、既往消化道出血病史等,但研究发现在阿司匹林及非甾体类抗炎药相关消化道出血的患者中,多达60%的患者并不属于传统的高危人群,进一步在非高危人群中寻找新的预测因子具有重要的临床意义。高胃酸分泌状态和幽门螺旋杆菌(Helicobater pylori,Hp)感染是消化性溃疡的病因,但是否也是阿司匹林相关性胃肠粘膜损伤的风险因子仍缺乏相关研究。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,本研究拟通过探讨血清PG和G17分泌水平及Hp感染状态与阿司匹林相关性胃肠粘膜损伤的相关性,判断可否将这些指标用于预测阿司匹林相关胃肠粘膜损伤。目的:探讨可否通过检测血清PG,G17水平及Hp感染状态预测阿司匹林相关胃肠粘膜损伤,为临床医师提供可行而有效的策略对阿司匹林相关性胃肠粘膜病变高危人群进行识别,针对性的给予PPI一级预防。方法:长期服用低剂量阿司匹林至少1个月的患者被纳入本研究;血清PGⅠ、PGⅡ及G17采用酶联免疫法(ELISA)检测;Hp感染检测采取14C呼气试验;胃肠粘膜损伤评分参考改良LANZA胃镜评分标准。结果:总共入选60例患者,其中15人属于重度胃肠粘膜损伤组。在重度胃肠粘膜损伤组中PGⅠ分泌水平显著高于轻度胃肠粘膜损伤组(156.9?39.1 VS.118.1?46.6ng/ml,P=0.04);在重度胃肠粘膜损伤组中患者Hp感染率明显高于轻度胃肠粘膜损伤组(73%VS.40%,P=0.03);PGⅡ和G17在两种人群中未显示出统计学差异;ROC曲线提示PGⅠ的临界值为:123ng/ml(灵敏度为80%,特异性为61.4%);Hp感染联合PGⅠ?123ng/ml(HPGI)预测阿司匹林相关性胃肠粘膜病变风险增高15.8倍(OR=15.8 95%CI,24?104.5)。Hp感染联合HPGI对阿司匹林相关胃肠粘膜损害的阳性预测值为90%、阴性预测值为76%、阳性似然比为10、阴性似然比0.3、敏感性69%、特异性93%、准确性81%。通过对阿司匹林所致的胃肠粘膜损伤危险因素的单因素和多因素分析发现性别、年龄、吸烟史、饮酒史、PG II及G17不是阿司匹林所致的胃肠损伤的独立风险因子,而PG I及Hp感染则是阿司匹林导致的胃肠损伤的独立风险因子(P0.05)。结论:血清PGⅠ和Hp感染可以用来识别阿司匹林相关性胃肠粘膜损伤高危人群,针对性的给予质子泵抑制剂(proton pump inhibitor,PPI)一级预防。
[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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