2021 年第 3 期 第 16 卷

双联抗血小板治疗对胃和小肠黏膜损伤的影响

Effects of dual antiplatelet therapy on gastric and small intestinal mucosal injuries

作者：柳海宁张杰高峰孙亚梅

英文作者：Liu Haining Zhang Jie Gao Feng Sun Yamei

单位：首都医科大学附属北京安贞医院消化内科100029

英文单位：Department of Gastroenterology Beijing Anzhen Hospital Capital Medical University Beijing 100029 China

关键词：双联抗血小板治疗；胃黏膜损伤；小肠黏膜损伤；磁控胶囊内镜

英文关键词：Dualantiplatelettherapy;Gastricmucosalinjury;Smallintestinalmucosalinjury;Magneticallycontrolledcapsuleendoscopy

• 摘要：

• 目的 探讨双联抗血小板治疗(DAPT)对胃和小肠黏膜损伤的影响。方法 选择2017年9月至2020年9月在首都医科大学附属北京安贞医院就诊的同时服用肠溶阿司匹林和氯吡格雷的患者24例（DAPT组），单用肠溶阿司匹林治疗的患者48例（阿司匹林组），体检健康的志愿者24例（健康对照组）。3组研究对象均接受磁控胶囊内镜检查，比较2组抗血小板治疗患者的患病情况和经皮冠状动脉介入比例，3组研究对象的年龄、体重指数、胃肠道症状评分以及磁控胶囊内镜检查胃溃疡、小肠溃疡、小肠黏膜糜烂、胃黏膜损伤Lanza评分、胃检查时间、小肠通过时间和腹部不适发生情况。结果 3组研究对象年龄、体重指数、胃肠道症状评分比较差异均无统计学意义（均P＞0.05）。DAPT组患高血压、糖尿病、心房颤动、脑梗死、高脂血症比例与阿司匹林组比较差异均无统计学意义（均P＞0.05），冠心病（冠状动脉粥样硬化性心脏病）和经皮冠状动脉介入比例高于阿司匹林组［100.0%(24/24)比29.2%（14/48），95.8%(23/24)比14.6%（7/48）］（均P＜0.001）。DAPT组和阿司匹林组胃溃疡、小肠溃疡、小肠黏膜糜烂比例和胃黏膜损伤Lanza评分均高于健康对照组［25.0%(6/24)、12.5%（6/48）比0,25.0%（6/24）、14.6%（7/48）比0,70.8%（17/24）、68.8%（17/48）比8.3%（2/24），2.0(2.0,4.0)、2.0(1.0,3.0)分比1.0(0,2.0)分］，且DAPT组胃溃疡比例高于阿司匹林组（均P＜0.05）,3组研究对象胃检查时间、小肠通过时间和腹部不适发生率比较差异均无统计学意义（均P＞0.05），胶囊分别在检查后1～5 d顺利排出体外。结论 接受DAPT和单独应用阿司匹林患者的胃和小肠黏膜损伤均较体检健康志愿者明显增加，且接受DAPT患者胃溃疡发病率较单用肠溶阿司匹林患者明显增加。

• Objective To investigate the effects of dual antiplatelet therapy (DAPT) on gastric and small intestinal mucosal injuries. Methods From September 2017 to September 2020, 24 patients taking concomitant enteric-coated aspirin and clopidogrel (DAPT group), 48 patients taking single concomitant enteric-coated aspirin (aspirin group), and 24 healthy volunteers by physical examination (healthy control group) admitted to Beijing Anzhen Hospital, Capital Medical University were enrolled. All subjects underwent magnetically controlled capsule endoscopy (MCCE). The prevalence and the rate of percutaneous coronary intervention between the two antiplatelet therapy groups were compared. Age, body mass index, gastrointestinal symptom rating score, and gastric ulcer, small intestinal ulcer, small intestinal mucosal erosion, gastric mucosal injury Lanza score, gastric examination time, small intestinal transit time detected by MCCE, as well as abdominal discomfort among the three groups were compared. Results There were no significant differences in age, body mass index and gastrointestinal symptom rating score among the three groups(all P>0.05). There were no significant differences in the rates of hypertension, diabetes mellitus, atrial fibrillation, cerebral infarction and hyperlipidemia between DAPT group and aspirin group(all P>0.05). The rates of coronary atherosclerotic heart disease and percutaneous coronary intervention in DAPT group were higher than those in aspirin group［100.0%(24/24) vs 29.2%（14/48）， 95.8%(23/24) vs 14.6%（7/48）］(both P<0.001). The rates of gastric ulcer, small intestinal ulcer, small intestinal mucosal erosion and gastric mucosal injury Lanza score in DAPT group and aspirin group were significantly higher than those in healthy control group［25.0%(6/24), 12.5%（6/48） vs 0; 25.0%（6/24）,14.6%（7/48） vs 0; 70.8%（17/24）, 68.8%（17/48） vs 8.3%（2/24）; 2.0(2.0,4.0), 2.0(1.0,3.0) vs 1.0(0,2.0)］, and the rate of gastric ulcer in DAPT group was higher than that in aspirin group (all P<0.05). There were no significant differences in gastric examination time, small intestine transit time and abdominal discomfort rate among the three groups(all P>0.05). All capsules were discharged from the body 1-5 d after the examination. Conclusions Gastric and small intestinal mucosal injuries in patients taking DAPT and single aspirin are significantly increased compared to healthy volunteers. The morbidity of gastric ulcer in patients taking DAPT is significantly increased compared with patients taking single aspirin.