徐敏

(无锡人民医院消化内科,江苏 无锡　214037)



胃蛋白酶原与丙二醛水平对胃溃疡并发上消化道出血的预测价值

徐敏

(无锡人民医院消化内科,江苏 无锡214037)

目的：分析胃溃疡(gastric ulcer,GU)合并上消化道出血的相关危险因素，并探讨血清胃蛋白酶原(pepsinogen,PG)与丙二醛(malondialdehyde,MDA)水平对其预后判断的价值。方法：选择自2013年1月至2016年1月无锡人民医院住院并确诊为GU合并上消化道出血的426例患者作为研究组，选择同期门诊GU无上消化道出血的874例患者为对照组。对GU合并上消化道出血的相关危险因素进行多因素Logistic回归分析，利用ROC曲线分析相关指标的预测价值。结果：(1)单因素分析显示，两组间近期服用NSAIDs、HP感染、年龄>60岁、O型血、PGⅠ、PGⅡ、MDA差异有统计学意义(P<0.05)；(2)多因素Logistic回归分析显示，近期服用NSAIDs、HP感染、MDA、PGⅠ、PGⅡ是GU合并上消化道出血的独立危险因素(P<0.05)；(3)ROC曲线显示，PGⅠ、PGⅡ、MDA曲线下面积分别为0.774、0.776、0.749；最佳阈值分别为77.5 μg/L、31.75 μg/L、8.68 μmol/L时,其预测GU并上消化道出血的敏感度分别为0.722、0.806、0.767；特异度分别为0.860、0.692、0.779。结论：联合PGⅠ、PGⅡ及MDA水平对GU合并上消化道出血具有较高的预测价值。

胃溃疡；上消化道出血；胃蛋白酶原；丙二醛；危险因素；预测价值

【Abstract】Objective：To investigate the related risk factors of gastric ulcer (GU)complicated with upper gastrointestinal hemorrhage and observe the predictive value of Pepsinogen(PG),Malondialdehyde (MDA)to GU complicated with upper gastrointestinal hemorrhage.Methods：426 cases of upper gastrointestinal hemorrhage with GU admitted to the gastroenterology department of Wuxi People’s Hospital between January 2013 and January 2016 as the study group;the same period 874 GU cases of patients with no gastrointestinal bleeding as the control group.A multi-factor Logistic regression was performed to analyze the risk factors associated with the incidence of GU complicated with upper gastrointestinal hemorrhage,and the predictive value was verified on the risk factors by Receiver operating characteristic (ROC)curve.Results：(1)Univariate analysis showed that use of NSAIDs,HP infection,over the age of 60,blood type O,PGⅠ,PGⅡ,MDA were significantly different between the two groups (P<0.05).(2)Multi-factor Logistic regression indicated that use of NSAIDs,HP infection,MDA,PGⅠ,PGⅡ were the independent risk factors for the onset of upper gastrointestinal hemorrhage with GU (P<0.05).(3)ROC curve analysis revealed that the optimal cutoff of PGⅠto predict GU complicated with upper gastrointestinal hemorrhage is 77.5 μg/L (AUC=0.774,sensitivity 0.722,specificity 0.860),the optimal cutoff of PGⅡto predict that is 31.75 μg/L (AUC=0.776,sensitivity 0.806,specificity 0.692)and the optimal cutoff of MDA to predict that is 8.68 μmol/L (AUC=0.749,sensitivity 0.767,specificity 0.779).Conclusion：It is proved that the therapy of PGⅠand PGⅡcombined with MDA have a higher value in the early prediction in GU complicated with upper gastrointestinal hemorrhage.

胃溃疡(gastric ulcer，GU)是消化内科常见的胃肠道疾病，由各种物理和化学性因素刺激、病原微生物感染、机体氧化应激及服用损伤胃黏膜药物等引起，以上各种因素均可引起胃黏膜糜烂、破溃等表现[1-2]。上消化道出血是胃溃疡最常见的并发症，大多数出血量在300～500 mL，当出血量>800 mL时可能会出现体循环休克甚至危及生命，故早期预防及避免GU并上消化道出血至关重要。因此对GU患者并上消化道出血的相关危险因素进行分析，如近期服用非甾体抗炎药(nonsteroidal anti-inflammatory drugs，NSAIDs)、幽门螺杆菌(helicobacter pylori，HP)感染、年龄>60岁、O型血、吸烟、饮酒等，并用统计学方法分析GU并上消化道出血的独立危险因素，这对于早期针对性预防上消化道出血能够起到指导性作用。胃蛋白……