The Effect Of Hp Eradication On Upper Gastrointestinal Bleeding Caused By Dual Anti-platelet Therapy After PCI In Patients With Coronary Heart Disease

Background:Over the years,anti-platelet therapy（APT）has become the main treatment for coronary atherosclerotic heart disease（CHD）.Long-term use of anti-platelet drugs can effectively reduce the incidence of cardiovascular and the cerebrovascular events resulting from the ischemia,but the risk of gastrointestinal bleeding is significantly increased.Helicobacter pylori（Hp）is planted in the stomach of the human body and releases urase,esterases,proteases etc,which can cause digestive diseases such as peptic ulcer,chronic gastritis and gastric adenocarcinoma.It is an important risk factor for gastrointestinal bleeding of patients.Studies have shown that Hp infection is closely related to ischemic cardiovascular and cerebrovascular diseases such as cerebral infarction and coronary heart disease.Therefore,it is particularly important for patients with coronary heart disease who have Hp infection to prevent upper gastrointestinal bleeding while undergoing anti-platelet therapy.Under the principle of informed consent,this study,underwent Hp radicalization for patients with Hp infected coronary artery disease undergoing percutaneous coronary intervention（PCI）Meanwhile,it will not Only investigate the occurrence of upper gastrointestinal hemorrhage after Hp infection and dual anti-platelet therapy（DAPT）after PCI in patients with coronary heart disease,and the effects of Hp-infection for C-Reaction protein（CRP）and low density lipoprotein（LDL）;but also observe the relationship between eradication of Hp in reducing the risk of upper gastrointestinal bleeding and anti-atherosclerosis in such patients.There is no consensus whether there is a need to eradicate Hp therapy during dual anti-platelet aggregation after PCI for patients with Hp-infected coronary heart disease.Objective:To evaluate the relationship between Hp infection and post-percutaneous coronary intervention（PCI）dual anti-platelet therapy（DAPT）induced upper gastrointestinal（GI）hemorrhage in coronary heart disease（CHD）as well as changes in relevant indicators,and to evaluate the effect of Hp eradication on lowering the risk of upper GI hemorrhage.Methods:Based on the ¹³C-urea breath test(¹³C-UBT)results,568 CHD patients received PCI were divided into Hp⁺group（n=308）and Hp^-group（n=260）,and the Hp⁺group was further divided into Hp⁺elimination（Hp⁺E）group（n=208）and Hp⁺uncured（Hp⁺U）group（n=100）.All patients received DAPT（clopidogrel and aspirin）,anti-atherosclerosis treatment with atorvastatin and mucous protection with pantoprazole.The Hp⁺E group received standardized quadruple therapy for two weeks,and patients in all three groups were under follow-up observation for one year.The data collected include:gender,age,body mass index（BMI）,hypertension history,smoking history,hyperlipemia history,diabetes history,heart failure history and Hp infection history.Based on whether a GI hemorrhage happened,the patients were then re-divided into hemorrhage group and non-hemorrhage group followed with correlation analysis between hemorrhage and data collected.We also tested the prothrombin time（PT）,creatinine（Cr）,alanine aminotransferase（ALT）,low density lipoprotein（LDL）,hemoglobin（Hb）and C-reaction protein（CRP）,and recorded the incidence of recurrent angor pectoris,nonfetal myocardial infarction and heart failure.Results:1.The results of 1-year follow-up showed that 19 Hp⁺patients（6.17%）encountered the upper GI hemorrhage.The basic data of the bleeding group and the non-bleeding were statistically tested,the multi-factor analysis showed that the gender,age,diabetes,smoking history,heat failure,Hp infection situation has significant difference（P<0.05）of distribution between the two groups.Among the various factors,male,aged,diabetes,smoking,heart failure and Hp infection had higher proportion in hemorrhage group（P<0.05）,whereas BMI,hypertension and hyperlipemia showed no prominent difference（P>0.05）.2.Univariate analysis using Logistic regression（LR）analysis considering the age,gender,diabetes,smoking,heart failure and Hp infection showed that age,diabetes,heart failure and Hp infection are independent risk factors of upper GI hemorrhage（OR>1）,while other factors are not（P>0.05）.3.There were 5 in Hp⁺E group（2.4%）,14 in Hp⁺U group（14%）and 0 patient in Hp^-group encountered upper GI hemorrhage.Incidence of hemorrhage in Hp⁺U group was much higher than in Hp⁺E group and Hp^-group（P<0.05）.Hb,LDL and CPR in Hp⁺U group showed significant difference between Hp⁺E group and Hp⁺U group（P<0.05）,while no difference seen between Hp^-group and Hp⁺E group（P>0.05）.No difference of PT,Cr and ALT seen in all three groups（P>0.05）.One year follow-up results showed significant difference of the incidence of recurrent angor pectoris,nonfetal myocardial infarction and heart failure in Hp⁺U group,compared with Hp⁺E group and Hp^-group（P<0.05）.Conclusion:Hp infection is a independent risk factor of DAPT induced upper GI hemorrhage in CHD patient receiving PCI treatment.Hp elimination could reduce the risk of the upper GI hemorrhage and benefit patients.