Clinical Analysis Of The Cases With Type 2 Diabetes Complicated With Upper Gastrointestinal Hemorrhage

Objective:To explore the high risk factors of upper gastrointestinal hemorrhage in the patients with type 2 diabetes (T2D) after taking aspirin, and to make early preventions and interventions in diabetes comprehensive management.Methods:We enrolled 58 T2D patients with upper gastrointestinal hemorrhage from January 2010 to January 2015 in Tonglu 1st people’s hospital. The patients were divided into two groups by the previous medication history of aspirin. The patients with aspirin medication history were treated as observation group, and the others were the control group. The clinical characteristics, such as the disease duration, the diabetic complications and the levels of fasting blood glucose, glycosylated hemoglobin, fasting C peptide, serum lipid profile, and hemoglobin etc., were compared between the two groups. Furthermore, the clinical manifestation of the gastric mucosal lesions under endoscopy, and the Helicobacter Pylori infection rate were also observed and analyzed.Results:1.The morbidity of upper gastrointestinal hemorrhage in T2D was significantly higher in male than in female (p<0.05), The age in the observation group was obviously older than the control group, and the diabetic duration was longer as well(both p<0.05); 2. The complications incidence and the level of serum creatinine in the observation group were significantly higher than the control group (p<0.05); 3.The levels of fasting blood glucose and glycosylated hemoglobin in the observation group was markedly lower than the control group(p<0.05); 4.There was no differences in the levels of fasting C peptide, blood lipid profile, hemoglobin, the clinical features, the characteristics under the endoscopy, and the Helicobacter Pylori infection rate(allp>0.05).Conclusions:1. The T2D patients with upper gastrointestinal hemorrhage who took aspirin had an elder age and longer disease duration than the ones without aspirin use;2.The chronic complications incidence in T2D patients with upper gastrointestinal hemorrhage who took aspirin was higher than the ones without aspirin use, especially the complication of the renal function impairment;3.After taking aspirin, male T2D patients were prone to have upper gastrointestinal hemorrhage than the female ones. The typical rhythmic pain and ulcer hemorrhage were always absent. The clinical feature of abdominal distension, epigastria discomfort, melena, fecal occult blood were more frequent. So, the clinical features were obscure and not easy to diagnose;4.There were no differences in the gastric mucosa characteristics under endoscopy. The Helicobacter Pylori infection rate, the levels of serum lipid profile and hemoglobin were similar between the two groups;5.The levels of fasting blood glucose and glycosylated hemoglobin in the observation group were much lower than the control group.In conclusion, the clinicians should make an assessment on risk factors of upper gastrointestinal hemorrhage in T2D patients before prescription of aspirin. The clinical feature such as the patient’s age, diseases duration and the chronic complications should be evaluated in detail. The clinicians should pay more attention to follow-up and monitor the aged patients with long diabetic duration, various complications, particularly with the renal function impairment, after they took aspirin. And it is a simple and effective self-monitoring method to tell patients to monitor the black stool after they took aspirin.