国内急性胃粘膜病变临床特点荟萃分析

国内急性胃粘膜病变临床特点荟萃分析

目的总结我国急性胃粘膜病变病例的临床特点、内镜特征、治疗及预后，以提高对该病的认识，指导临床工作。方法对2000年1月，2014年11月国内公开发表的20篇关于急性胃粘膜病变共2072例进行回顾性分析。结果①2299例患者中，男性显著多于女性，男女比为1.7：1，平均年龄42.4岁；该类患者占同期上消化道出血患者的20.3～30.4%。②最常见病因是药物所致急性胃粘膜病变，占36.6%，其中NSAIDS、抗凝血药物及皮质激素占33.2%（763/2299）；约64.3%患者发病前有上腹部疼痛不适，25.7%患者以突发黑便或/和呕血为首发症状。③92.2%（2120/2299）的患者经内镜明确诊断，6.1%（140/2299）患者因病情重不能耐受胃镜检查而行血管造影、消化道造影等明确病灶，1.7%（39/2299）患者未行上述检查（或不能耐受上述检查）具体病灶诊断不清。所有患者均使用药物治疗进行止血，其中64.1%病人同时行内镜治疗，成功率93.8%；总体内科保守治疗成功率为96.3%，仅有极少数病人1.2%（20/1644）经内镜下止血无效行胃大切手术；所有患者中死亡41例，死亡率为2.5%（41/1644），其中死于原发病的占72.7%，死于出血的占28.3%。④急性胃粘膜病变发病部位以胃体及胃窦为主，占83.9%，其他部位有十二指肠、食管等。内镜表现以多发性粘膜充血糜烂为主，占67.4%。⑤资料显示急性胃粘膜病变预后与内镜下表现明显相关，病变部位越大、溃疡愈深其死亡率及外科手术机会愈大。结论急性胃粘膜病变是上消化道出血常见的原因之一，多数患者以黑便和呕血为首发症状，急诊内镜检查和内镜下止血治疗是其主要诊断和治疗方法，可改善其预后。

Abstract：Objective The aim of this study was to summerize the clinical features in patients with acute gastric mucosal lesions in China. Methods The clininal datas of 2299 cases with acute gastric mucosal lesions were collected from 20 published papers in Chinese literature during the periods of Jan. 2000 to Dec. 2014. Results Among all these 2299 patients，male patients were obviously more than female patients （1.7：1）. The average age was 42.4 years old. The patients accounted for （20.3-30.4）percent of patients with upper gastrointestinal bleeding in the same period. the most common cause is drug-induced acute gastric mucosal lesion，accounting for 36.6%，which NSAIDS，antiplatelet drugs and corticosteroids accounted for 33.2% （763/2299）；about 64.3% of the patients before the onset of upper abdominal pain and discomfort，25.7% of patients with sudden melena and / or vomiting as the first symptom，⑶92.2% （2120/2299）of patients diagnosed by endoscopy，6.1% （140/2299）patients due to severe illness can not tolerate the endoscopy and angiography，gastrointestinal contrast and so clear the digestive tract lesions，1.7% （39/2299）line of the check were not （or can not tolerate the examination）diagnosis of specific lesions is unclear. All patients were treated with drugs to stop bleeding，both of which 64.1% of the patients underwent endoscopic therapy，the success rate of 93.8%；the overall success of conservative treatment was 96.3%，only a very small number of patients 1.2% （20/1644）by Endoscopic hemostasis of gastric large cutting operation is invalid；41 cases of death in all patients，the mortality rate was 2.5% （41/1644），of which 72.7% died of primary

disease，died of bleeding accounted for 28.3%. ⑷incidence of acute gastric mucosal lesion in the gastric body and antrum area，accounting for 83.9%，other parts of the duodenum，esophagus and so on. Endoscopic mucosal congestion with multiple erosion，accounting for 67.4%.（5）the prognosis of acute gastric mucosal lesions significantly correlated with the endoscopic features，the larger lesions，ulcers and surgical mortality deeper much higher. Conclusion Acute gastric mucosal lesions are common causes of upper gastrointestinal bleeding，one of the majority of patients with melena and hematemesis as the first symptom，emergency endoscopy and endoscopic hemostasis is the main method of diagnosis and treatment can improve the prognosis.Key words：Acute gastric mucosal lesion；Morbility；Diagnosis；Treatment

急性胃粘膜病变（acute gastric mucosal lesions，AGML）是上消化道出血常见的原因之一，近些年来随着心脑血管疾病、风湿性疾病发病的增加及抗血小板药物和风湿止痛药物的使用增加，有关AGML的报道较前明显增加，为了更好地了解该病的临床特点，本文对国内文献报道的急性胃粘膜病变临床特点进行荟萃分析，以提高对该病的认识，改善预后。

1资料与方法

1.1一般资料应用计算机检索中国知网及维普数据库，时间限制为“2000-01/2015-01”，检索词”急性胃粘膜病变”，共检索到相关文献67篇，对符合纳入标准的文献进行荟萃分析，纳入标准：①AGML。②资料完整且能与其他资料综合分析。排除标准：重复研究。最终纳入20篇文献[1-20]共包括2299例资料完整的急性胃粘膜病变病例进行综合统计分析。

1.2方法对纳入分析的2299例急性胃粘膜病变患者的发病年龄特点、性别构成情况、临床特征、诊断、治疗及预后等因素进行荟萃分析，以了解该病的发病特点、临床特征、诊断方法及治疗措施，最终为提高对该病的认识，指导临床工作并改善预后提供依据。

2结果

2.1临床特点2299例患者男1407例，女892例，男∶女=1.7∶1，年龄14～86岁，平均42.4岁。既往有消化性溃疡、慢性胃炎或有消化道症状的有86例。约64.3%患者发病前有上腹部疼痛不适，25.7%患者以突发黑便或/和呕血为首发症状。

发病前多有明显诱因，常见的诱因包括：①药物因素1045例，45.5%摘要是36%，其中NSAIDS、抗凝血药物及皮质激素763例，占73.0%；②中枢神经系统疾病包括颅脑外伤、脑出血等共225例，占9.8%；③严重灼伤48例，2.3%；

④严重内科疾病364例，占15.8%；⑤酒精中毒及暴饮暴食278例，12.1%；⑥严重外科疾病包括术后及严重创伤104例，4.5%；⑦精神紧张42例，占1.8%；

⑧其他：包括过度疲劳及不明原因等共241例，占10.5%。