Risk Factors And Treatment Of Acute Non-variceal Upper Gastrointestinal Bleeding With Gout

Objective:To investigate the risk factors in patients with acute non-variceal upper gastrointestinal bleeding and acute gout who had a history of gout,and to compare the effects of low-dose glucocorticoids and NSAIDs on the treatment of acute gout on the basis of acute non-variceal upper gastrointestinal bleeding.Methods:1.Patients with acute non-variceal upper gastrointestinal bleeding who had a history of gout from the Second Affiliated Hospital of Dalian Medical University were enrolled from August 1st 2008 to August 1st 2019.Forty patients with acute attacks were taken as the research objects,and 46 patients with no gout attacks during the same period were used as the control group.2.Relevant data were analyzed retrospectively,including: basic information(age,gender,height,weight);basic medical history(hypertension,type 2 diabetes,cardiovascular disease,kidney disease);previous history(smoking history,drinking history);Etiology of upper gastrointestinal bleeding(esophageal lesions,acute gastric mucosal lesions,peptic ulcers,other lesions);first partial blood biochemical examination on admission(urea,uric acid,creatinine,hemoglobin,albumin,cholesterol,triglycerides,high density Lipoprotein,low-density lipoprotein);upper gastrointestinal bleeding treatment(omeprazole,lansoprazole,pantoprazole,isomeprazole,and blood transfusion).3.By univariate and Logistics multivariate regression analysis the risk factors ofacute non-variceal upper gastrointestinal bleeding with acute gout in patients with a history of gout were clarified.In addition,we compared the effects of low-dose glucocorticoids and NSAIDs on the treatment of acute gout on the basis of acute non-variceal upper gastrointestinal bleeding.Result:1.There were 86 cases of acute non-variceal upper gastrointestinal bleeding with a history of gout,of which 46.51%(40/86)had acute attacks of gouty arthritis of varying degrees.2.Univariate analysis showed that BMI(26.74vs24.92),cholesterol(4.27vs3.72)and triglycerides(2.08vs1.63)were related to the acute attack of gout(P <0.05).Multivariate Logistic regression analysis showed that there was no independent correlation between BMI,cholesterol,and triglycerides(P> 0.05).3.Prediction capabilities of three models of BMI,cholesterol and triglyceride revealed: BMI diagnosis boundary was 26.02,sensitivity wad 0.625,specificity was0.696,and Jordan index reached the highest 0.321;cholesterol diagnosis boundary was 5.17,the sensitivity was 0.325,the specificity was 0.935,and the Jordan index reached the highest 0.260.The area under the BMI and cholesterol curves were both>0.5,and the prediction effect was better.The predictive effect of triglycerides was not good,and there was no statistical significance(P> 0.05).4.The low-dose glucocorticoids had a significantly better remission date(5.00vs7.00)for gout acute exacerbations than NSAIDs(P <0.05).Conclusion:1.BMI,cholesterol and triglycerides are risk factors for acute non-variceal upper gastrointestinal hemorrhage with gout,but are not independent risk factors.2.BMI and cholesterol are closely related to acute non-variceal upper gastrointestinal bleeding with acute onset of gout,and regular detection and monitoring can better control disease progression.3.Both low-dose glucocorticoids and NSAIDs have better efficacy with safety for the treatment of acute gout in patients with acute non-variceal upper gastrointestinal bleeding.However,compared to NSAIDs,patients using low-doseglucocorticoids show faster pain relief.