目的:虽然有几种药物可引起小肠粘膜损伤,目前尚不清楚这些损伤是否会导致明显的小肠出血.这项研究旨在评估疾病相关人群中药物使用与小肠粘膜损伤之间以及这些粘膜损伤与明显出血之间的关系。
方法:我们回顾性研究了2010年至2013年间接受胶囊内镜检查的疑似小肠疾病患者。药物暴露,Charlson合并症指数,吸烟,在胶囊内窥镜检查前评估酒精消耗。估计小肠粘膜损伤和小肠明显出血的调整比值比(AOR)和置信区间(CI)。
结果:总计,在研究期间分析了850名患者。中位年龄为64岁,544例(64.0%)为男性。小肠粘膜损伤(n=60)和无粘膜损伤(n=705)的患者中,与非使用相比,使用非甾体类抗炎药(NSAIDs)(AOR1.8,95%CI1.01~3.31)与小肠粘膜损伤风险增加显著相关.对有明显出血(n=85)和无明显出血(n=60)的小肠粘膜损伤患者进行比较,两组之间非甾体抗炎药的使用率没有显着差异,噻吩并吡啶,其他抗血小板,抗凝剂,对乙酰氨基酚,盐酸曲马多,或者发现了类固醇,即使在调整了混杂因素之后。
结论:尽管使用NSAIDs与小肠粘膜损伤的风险增加显著相关,未观察到此类药物的使用与小肠明显出血之间存在显著关联.
OBJECTIVE: Although several drugs may induce small-bowel mucosal injuries, it is unclear whether these injuries contribute to overt small-bowel bleeding. This study was designed to evaluate the associations between drug use and small-bowel mucosal injury and between these mucosal injuries and overt bleeding in a disease-relevant population.
METHODS: We retrospectively studied patients with suspected small-bowel diseases who underwent capsule endoscopy between 2010 and 2013. Drug exposure, Charlson Comorbidity Index, smoking, and alcohol consumption were assessed before capsule endoscopy. Adjusted odds ratios (AOR) and confidence intervals (CI) were estimated for small-bowel mucosal injury and small-bowel overt bleeding.
RESULTS: In total, 850 patients were analyzed during the study period. Median age was 64 years, and 544 patients (64.0%) were men. Among the patients with small-bowel mucosal injury (n = 60) and without mucosal injury (n = 705), use of non-steroidal anti-inflammatory drugs (NSAIDs) (AOR 1.8, 95% CI 1.01-3.31) was significantly associated with an increased risk of small-bowel mucosal injury compared with non-use. Patients with small-bowel mucosal injury with overt bleeding (n = 85) and without overt bleeding (n = 60) were compared, and no significant difference between the groups in the usage rates for NSAIDs, thienopyridine, other antiplatelets, anticoagulants, acetaminophen, tramadol hydrochloride, or steroids was revealed, even after adjusting for confounders.
CONCLUSIONS: Although the use of NSAIDs was significantly associated with an increased risk of small-bowel mucosal injury, no significant associations were observed between the use of such drugs and small-bowel overt bleeding.