李群山 宋斌 梁桂玲

[摘要]目的 探讨根除幽门螺杆菌（Hp）对冠心病患者长期小剂量服用阿司匹林致上消化道黏膜损伤的影响，为临床决策提供依据。方法 选取2014年1月～2015年12月我院诊治的105例冠心病合并Hp感染患者为研究对象，采用随机数字表法将其分为Hp根除组（n=52）和对照组（n=53）。Hp根除组按标准方案治疗Hp，对照组常规治疗，随访6个月，比较两组的消化道症状和上消化道黏膜损伤发生率。结果 随访6个月后，Hp根除组和对照组消化道症状（疼痛、反酸、黑便、大便潜血阳性）发生率分别为19.2%和49.1%;上消化道黏膜伤发生率分别为7.7%和22.6%;Hp根除组消化道症状和上消化道黏膜损伤总發生率低于对照组，差异有统计学意义（P<0.05）。结论 根除Hp可降低长期小剂量服用阿司匹林冠心病患者上消化道黏膜损伤风险。

[关键词]冠心病;阿司匹林;幽门螺杆菌

[中图分类号] R573.1          [文献标识码] A          [文章编号] 1674-4721（2020）7（b）-0040-03

Impact of Helicobacter pylori eradication therapy and low dose Aspirin on upper digestive tract mucosal injury among patients with coronary heart disease

LI Qun-shan1   SONG Bin2   LIANG Gui-ling2

1. Department of Laboratory Medicine， Huizhou Traditional Chinese Medicine Hospital， Guangdong Province， Huizhou 516001， China; 2. Endoscopy Center， Huizhou Traditional Chinese Medicine Hospital， Guangdong Province， Huizhou   516001， China

[Abstract] Objective To investigate the impact of Helicobacter pylori eradication therapy （Hp） and low dose Aspirin on upper digestive tract mucosal injury among patients with coronary heart disease， and to provide evidence for making clinical decision. Methods A total of 105 patients combined with coronary heart disease and Hp infection were selected from January 2014 to December 2015 in our hospital. The patients were divided into Hp group （n=52） and control group （n=53） by using random number table method. Hp group received anti-Hp treatment according to standard protocol， and control group received routine treatment. The patients were followed up for 6 months， the occurrence of gastrointestinal symptoms and upper gastrointestinal mucosal injury were observe between two groups. Results The occurrence of gastrointestinal symptoms in Hp group and control group was 19.2% and 49.1% respectively; the occurrence of upper gastrointestinal mucosal injury in Hp group and control group was 7.7% and 22.6% respectively. The total occurrence rates of gastrointestinal symptoms and upper gastrointestinal mucosal injury were lower in Hp group than those in the control group， the differences were statistically significant （P<0.05）. Conclusion To reduce the risk of gastrointestinal symptoms and upper gastrointestinal mucosal injury， patients combined with coronary atherosclerosis and Hp infectious should eradicate Hp infections.

[Key words] Coronary heart disease; Aspirin; Helicobacter pylori

阿司匹林也称乙酰水杨酸，是水杨酸类药物，通常用作镇痛、解热和消炎剂。阿司匹林对血小板聚集有抑制作用，能降低血液粘稠度，防止血栓形成，临床小剂量阿司匹林常用于预防短暂脑缺血发作、心肌梗死、人工心脏瓣膜术后血栓的形成等[1]。阿司匹林能抑制花生四烯酸合成黏膜保护因子前列腺素（PGs），因此长期服用小剂量阿司匹林对消化道黏膜有损伤作用，增加消化道出血风险[2]，如何降低阿司匹林致消化道黏膜损伤风险是重要的临床研究课题。幽门螺杆菌（Hp）是消化道溃疡常见病因，在我国感染率较高，为42%～66%[3]。有研究表明Hp感染增加长期服用小剂量阿司匹林患者上消化道黏膜损伤风险[4]，但既往研究结论并不一致，可能与研究对象的异质性有关。……