目的 探讨血清胃蛋白酶原(PG)、白细胞介素-8(IL-8)与老年非甾体类抗炎药(NSAIDs)相关性消化性溃疡出血的关系。方法 选取武警陕西总队医院2022-01至2023-12收治的老年NSAIDs相关性消化性溃疡患者110例,根据是否发生老年NSAIDs相关性消化性溃疡出血分为出血组(42例)和未出血组(68例)。收集两组患者一般资料并检测他们的血清胃蛋白酶原Ⅰ(PGⅠ)、胃蛋白酶原Ⅱ(PGⅡ)、IL-8水平,计算PGR(PGⅠ与PGⅡ的比值),采用logistic回归模型分析发生消化性溃疡出血的危险因素,采用受试者工作特征(ROC)曲线分析血清PG、IL-8水平评估发生消化性溃疡出血的价值。结果 出血组与未出血组老年NSAIDs相关性消化性溃疡患者年龄、性别、吸烟史、饮酒史、BMI、高血压、糖尿病、高脂血症、消化道疾病史、冠心病、贫血、NSAIDs用药种类比较,差异无统计学意义(P>0.05),出血组患者消化性溃疡史、服用NSAIDs时间、PGⅡ水平、IL-8水平均高于未出血组,PGⅠ、PGR水平均低于未出血组(P<0.05);经多因素logistic回归模型分析,消化性溃疡史(OR=1.193,95%CI:1.120~1.271)、服用NSAIDs时间(OR=8.177,95%CI:1.970~33.936)、IL-8(OR=1.252,95%CI:1.065~1.474)均为老年NSAIDs相关性消化性溃疡患者发生消化性溃疡出血的独立危险因素,PGR(OR=0.002,95%CI:0.000~0.091)为保护因素(P＜0.05);ROC曲线分析显示,PGR、IL-8单独预测消化性溃疡出血的受试者工作特征曲线下面积(AUC)(95%CI)分别为0.878(0.802~0.933)、0.832(0.749~0.896),采用log(P)联合预测AUC(95%CI)为0.947(0.888~0.981),联合预测效能比单独预测效能更好(P＜0.05)。结论 血清PGR、IL-8水平与老年NSAIDs相关性消化性溃疡出血密切相关,可作为评估患者病情和预后的指标。
Abstract
Objective To investigate the relationship between serum pepsinogen (PG), interleukin-8 (IL-8), and non-steroidal anti-inflammatory drugs (NSAIDs) related peptic ulcer bleeding in the elderly. Method A total of 110 elderly patients with NSAIDs related peptic ulcer admitted to Shaanxi Provincial Corps Hospital of Chinese People’s Armed Police Force from January 2022 to December 2023 were selected, and divided into a bleeding group (42 cases) and a non-bleeding group (68 cases) according to whether NSAIDs-associated peptic ulcer occurred in elderly patients. The general data of two groups were collected and the serum levels of gastric protease I (PGⅠ), gastric protease Ⅱ (PG Ⅱ), and IL-8 were detected. The PGR (ratio of PG-ⅰ to PG-ⅱ) was calculated. Logistic regression model was used to analyze the risk factors for peptic ulcer bleeding, and receiver operating characteristic (ROC) curve analysis was used to evaluate the value of serum PG and IL-8 levels for peptic ulcer bleeding. Results There was no significant difference in age, sex, smoking history, drinking history, BMI, hypertension, diabetes, hyperlipidemia, digestive tract disease history, coronary heart disease, anemia, or type of NSAIDs medication between the bleeding group and the non-bleeding group of elderly patients with NSAIDs related peptic ulcer (P>0.05). The history of peptic ulcer, time of taking NSAIDs, PG Ⅱ and IL-8 levels in the bleeding group were higher than those in the non-bleeding group, and the levels of PG Ⅰ and PGR were lower than those in the non-bleeding group (P<0.05); According to the analysis of multiple logistic regression models, history of peptic ulcer (OR=1.193,95%CI:1.120-1.271), time of taking NSAIDs (OR=8.177,95%CI:1.970-33.936), and IL-8 (OR=1.252,95%CI:1.065-1.474)were all independent risk factors for peptic ulcer bleeding in elderly NSAIDs related peptic ulcer patients, and PGR (OR=0.002,95%CI:0.000-0.091) was the protective factor (P<0.05); ROC curve analysis showed that the area under the working characteristic curve (AUC) (95%CI) of PGR and IL-8 alone for predicting peptic ulcer bleeding in subjects was 0.878(0.802-0.933) and 0.832(0.749-0.896), respectively. The log (P) combined prediction AUC (95%CI) was 0.947(0.888-0.981), and the combined prediction performance was better than that of single prediction (P<0.05). Conclusions Serum PGR and IL-8 levels are closely related to peptic ulcer bleeding associated with NSAIDs in elderly patients, and can be used as indicators to evaluate the condition and prognosis of patients.
关键词
胃蛋白酶原 /
白细胞介素-8 /
非甾体类抗炎药 /
消化性溃疡出血
Key words
pepsinogen /
interleukin-8 /
non-steroidal anti-inflammatory drug /
peptic ulcer bleeding
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参考文献
[1] Tuerk E, Doss S, Polsley K. Peptic ulcer disease[J]. Prim Care, 2023, 50(3):351-362.
[2] Izadi P, Izadi P, Salem R, et al. Non-steroidal anti-inflammatory drugs in the environment: where were we and how far we have come?[J]. Environ Pollut, 2020, 267:115370.
[3] Tai F W D, McAlindon M E. Non-steroidal anti-inflammatory drugs and the gastrointestinal tract[J]. Clin Med (Lond), 2021, 21(2):131-134.
[4] Domper Arnal M J, Hijos-Mallada G, Lanas A. Gastrointestinal and cardiovascular adverse events associated with NSAIDs[J]. Expert Opin Drug Saf, 2022, 21(3):373-384.
[5] 邓园园,周先宝,卢水焕,等.血清PGⅠ、PGⅡ、G-17、Hcy水平对阿司匹林致冠心病并发消化性溃疡出血的诊断价值[J].山东医药,2022,62(28):24-28.
[6] 戴新羽,刘佰纯,田月丽,等.非甾体类抗炎药对肠道黏膜损伤的影响[J].中南药学,2020,18(6):1042-1045.
[7] 王俊先,束 鹏,曹玉萍,等.消化性溃疡出血患者血清胃蛋白酶原和胃泌素水平的变化及临床意义[J].中国临床保健杂志,2021,24(4):498-501.
[8] 陆盛菊,金天淑.老年非甾体抗炎药相关消化性溃疡的临床特征及影响因素[J].中国老年学杂志,2020,40(3): 539-542.
[9] Wilkins T, Wheeler B, Carpenter M. Upper gastrointestinal bleeding in adults: evaluation and management[J]. Am Fam Physician, 2020, 101(5):294-300.
[10] Szeto C C, Sugano K, Wang J G, et al. Non-steroidal anti-inflammatory drug (NSAID) therapy in patients with hypertension, cardiovascular, renal or gastrointestinal comorbidities: joint APAGE/APLAR/APSDE/APSH/APSN/PoA recommendations[J]. Gut, 2020, 69(4):617-629.
[11] Lee M W, Katz P O. Nonsteroidal aantiinflammatory drugs, anticoagulation, and upper gastrointestinal bleeding [J]. Clin Geriatr Med, 2021, 37(1):31-42.
[12] Olsen A S, McGettigan P, Gerds T A, et al. Risk of gastrointestinal bleeding associated with oral anticoagulation and non-steroidal anti-inflammatory drugs in patients with atrial fibrillation: a nationwide study[J]. Eur Heart J Cardiovasc Pharmacother, 2020, 6(5):292-300.
[13] Amézqueta S, Beltrán J L, Bolioli A M, et al. Evaluation of the interactions between human serum albumin (HSA) and non-steroidal anti-inflammatory (NSAIDs) drugs by multiwavelength molecular fluorescence, structural and computational analysis[J]. Pharmaceuticals (Basel), 2021, 14(3):214.
[14] 代秀影,董 飞,徐 畅.NSAIDs对老年上消化道出血患者血清PGE-2和PGI-2影响及其与Hp感染的关系[J].热带医学杂志,2023,23(7):951-954.
[15] Qin Y, Geng J X, Huang B. Clinical value of serum pepsinogen in the diagnosis and treatment of gastric diseases[J]. World J Gastrointest Oncol, 2023, 15(7):1174-1181.
[16] Wu Q, Li W, Zhao J, et al. Apigenin ameliorates doxorubicin-induced renal injury via inhibition of oxidative stress and inflammation[J]. Biomed Pharmacother, 2021, 137: 111308.
[17] Zaman F Y, Orchard S G, Haydon A, et al. Non-aspirin non-steroidal anti-inflammatory drugs in colorectal cancer: a review of clinical studies[J]. Br J Cancer, 2022, 127(10): 1735-1743.
[18] Rogóz W, Pozycka J, Kulig K, et al. New look at the metabolism of nonsteroidal anti-inflammatory drugs: influence on human serum albumin antioxidant activity[J]. J Biomol Struct Dyn, 2023, 41(2):753-763.
[19] Bindu S, Mazumder S, Bandyopadhyay U. Non-steroidal anti-inflammatory drugs (NSAIDs) and organ damage: a current perspective[J]. Biochem Pharmacol, 2020, 180:114147.
[20] 陈 金,马建霞,于晓峰,等.老年人非甾体抗炎药相关性上消化道出血的临床特点[J].中国临床药学杂志,2020,29(3):177-181.
基金
陕西省中医管理局中医药科研课题(ZYMS016)
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