2020 年第 9 期 第 15 卷

老年非甾体抗炎药相关性消化性溃疡发病特点及诊治策略

Characteristics， diagnosis and treatment of senile nonsteroidal anti-inflammatory drug-associated ulcer

作者：田甜胡文炜王瑞玲蒋仁秀李雪

英文作者：Tian Tian Hu Wenwei Wang Ruiling Jiang Renxiu Li Xue mso-ascii-theme-font:minor-latin;mso-fareast-

单位：中国人民解放军火箭军特色医学中心消化内科，北京100088

英文单位：Department of Gastroenterology Chinese People′s Liberation Army Rocket Forces Characteristic Medical Center Beijing 100088 China

关键词：老年消化性溃疡；非甾体抗炎药；诊治策略

英文关键词：Pepticulcerinelders；Nonsteroidalanti-inflammatorydrug；Diagnosisandtreatmentstrategy

• 摘要：

• 目的 分析老年非甾体抗炎药（NSAID）相关性消化性溃疡(PUD)的发病特点及诊治策略。方法 回顾性选取2008年9月至2019年4月中国人民解放军火箭军特色医学中心收治的199例行胃镜检查诊断为老年PUD患者。根据患者服用药物病史分为NSAID组（59例）和对照组（140例），对照组发病前未服用过NSAID；NSAID组发病前均曾服用NSAID。比较2组的一般情况、临床表现、内镜下表现和幽门螺杆菌（Hp）阳性率。结果 NSAID组男性及溃疡伴活动性出血比例均高于对照组［78.0%(46/59)比61.4%(86/140)、94.9%(56/59)比45.7%(64/140)］，入院后最低血红蛋白水平低于对照组［（93±35）g/L比（111±29）g/L］，差异均有统计学意义（均P＜0.05）。NSAID组临床症状不典型，以呕血、黑便多见，腹痛、呕吐少见，与对照组比较差异均有统计学意义（均P＜0.05）。NSAID组内镜下表现以十二指肠溃疡多见（64.4%），其次为胃溃疡（32.2%）和胃十二指肠复合溃疡（3.4%），与对照组比较差异有统计学意义（P＜0.05）。2组溃疡分期、单发溃疡/多发溃疡、Hp阳性率比较，差异均无统计学意义（均P＞0.05）。结论 老年NSAID相关性PUD以男性、十二指肠溃疡居多，临床表现不典型且消化道出血发生率高，对于服用NSAID的胃肠道风险高危人群，应综合出血情况、个体化制定诊治策略。

• Objective To analyze the characteristics， diagnosis and treatment strategy of peptic ulcer disease (PUD) associated with nonsteroidal anti-inflammatory drug（NSAID）in the elderly. Methods From September 2008 to April 2019, 199 elderly patients with PUD diagnosed by gastroscopy admitted to Chinese People′s Liberation Army Rocket Forces Characteristic Medical Center were selected. According to the drug history, the patients were divided into NSAID group (59 cases) and control group (140 cases). The control group did not have NSAID and NSAID group had NSAID before the onset of the disease. The general condition, clinical manifestation, endoscopic manifestation and HP positive rate were compared between the two groups. Results The ratios of male and active bleeding in NSAID group were higher than those in control group［78.0%(46/59) vs 61.4%(86/140), 94.9%(56/59) vs 45.7%(64/140)］; the baseline hemoglobin level after admission was lower than that in control group ［（93±35）g/L vs （111±29）g/L］（all P＜0.05）. The clinical symptoms of NSAID group were not typical; hematemesis and melena were common; abdominal pain was rare and there was no vomiting; there were significant differences in clinical data between the NSAID group and control group (all P＜0.05). In NSAID group, duodenal ulcer was significantly more frequent (64.4%), followed by gastric ulcer (32.2%) and gastroduodenal compound ulcer (3.4%)(P＜0.05). There were no significant differences in ulcer stage, single ulcer/multiple ulcer and HP positive rate between the two groups (all P＞0.05). Conclusions NSAID-related peptic ulcers are mostly male and duodenal ulcers with atypical clinical manifestations and a high incidence of gastrointestinal bleeding. Patients should have comprehensive diagnosis and treatment.