Analysis Of Clinical Features And Risk Factors Of Upper Gastrointestinal Bleeding Induced By Aspirin

Object:Analysis the clinical features and risk factors of upper gastrointestinal bleeding caused by aspirin. Methods:Part 1: Cases of patients with upper gastrointestinal bleeding were collected from outpatients and inpatients in Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine from March, 2010 to April, 2014. According to the requirements, a total of 282 cases are enrolled, in which 98 cases taking aspirin were regarded as the observation group to analyze the clinical features of upper gastrointestinal bleeding caused by aspirin.Part 2: Cases of patients with upper gastrointestinal bleeding were collected from outpatients and inpatients in Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine from March, 2010 to April, 2014. According to the requirements, a total of 200 cases are enrolled, in which 98 cases with upper gastrointestinal bleeding were regarded as the Observation Group. Analysis the difference between The Observation Group and The Control Group,identify risk factors of upper gastrointestinal bleeding caused by aspirin.Part 3: Primary astric mucosal cells were cultured in the presence of aspirin(with or without chemotherapeutics) or not, then the cell were harvested and analyzed the effects of aspirin on primary gastric musol cells proliferation and chemotherapy toxicity. Results:Part 1:50 patients(51.02%) with upper gastrointestinal bleeding occurred within 1 month after taking aspirin, the percentage accounted for more than the half.In the observation group, the percentage of patients above 60-year-old was 63.3%. The proportion of patients with past history of peptic ulcers accounted for 48.98% and Hp infection rate was 59.18%. All results were higher than these of the Control Group.Patients with digestive tract symptoms in the Observation Group is 25(25.51%), while the number in Control Group accounted for 94(51.09%).The average level of hemoglobin(HB) in the Observation Group is 8.54g/dL, and the patients with a level below 9g/dL were 40(40.82%). The average level of hemoglobin(HB) in the Control Group is 9.67g/dL, and the level of 38 patients(20.65%)were below 9g/dL. The average level of hemoglobin(HB) in the former was lower than that in the control group, while the ratio of patients with a level below 9g/dL was higher than that of the control group.The Observation Group included 32 gastric ulcer(GU) patients(32.65%), 18 duodenal ulcer(DU) patients(18.37%), 6 patients with gastric ulcer combined duodenal ulcer(6.12%)and 42 patients with acute erosive gastritis(42.86%).In the Control Group, there are 30 gastric ulcer(GU) patients(16.30%), 109 duodenal ulcer(DU) patients(59.24%), 12 patients with gastric ulcer combined duodenal ulcer(6.52%)and 33 patients with acute erosive gastritis(17.94%). There were 32 patients with GU in the Observation Group, which included 10 patients with gastric body ulcers(31.25%), 9 patients with multiple ulcers(28.13%), 1 patient with cardia ulcer, 3 patients with bottom ulcers of stomach, 4 patients with gastric antrum ulcers, 5 patients with pyloric ulcers. There were 30 patients with GU in the Control Group, which included 7 patients with gastric body ulcers, 5 patients with multiple ulcers, 2 patient with cardia ulcer, 2 patients with bottom ulcers of stomach, 11 patients with gastric antrum ulcers, 3 patients with pyloric ulcers.Part 2:The gender, hypertension, myocardial infarction, cerebral infarction, TIA, use of antihypertensive drugs in two groups make no statistical significance(P>0.05).The difference between age, smoking, alcohol consumption, history of peptic ulcers, diabetes(DM), hyperlipemia, Hp infection in the two groups is statistical significant(P<0.05).Part 3: The number of cells in the observation group was less than that of the control group, furthermore, the cell optical density value of observation group with chemotherapy drugs was lower than the control group. Conclusion:1. Most upper gastrointestinal bleeding caused by aspirin occurred at the early stage of taking aspirin.2. With a latent onset and a large amount of hemorrhagic volume, upper gastrointestinal bleeding caused by aspirin often exists without any digestive tract symptoms.3. Acute gastric mucosa damage is the most common phenomenon in upper gastrointestinal bleeding caused by aspirin followed with large areas and multiple ulcers, which often occurred in gastric body.4. The risk factors of upper gastrointestinal bleeding caused by aspirin include advanced age(above 60 years old), smoking history,drinking history, past history of peptic ulcer, diabetes(DM) and Hp infection.5. The independent risk factors of upper gastrointestinal bleeding caused by aspirin are advanced age(above 60 years old), past history of peptic ulcer, diabetes(DM) and Hp infection.6. Aspirin can inhibit the proliferation of the primary gastric mucosal cells, but increase the effect of chenmotherapy drugs.