高原红细胞增多症与消化性溃疡出血的关系

doi:10.19723/j.issn.1671-167X.2022.01.025

摘要/Abstract

摘要：

目的: 探讨高原红细胞增多症(high altitude polycythemia,HAPC)与消化性溃疡出血的关系,以期为我国西藏地区消化性溃疡的临床诊治提供依据。方法: 选择2015年1月1日—2021年4月30日因消化性溃疡出血在西藏自治区人民医院消化内科住院的患者为病例组,以同一时期在泌尿外科住院的无消化性溃疡、无消化道出血病史的患者作为对照组,进行回顾性病例对照研究,按照性别、年龄(±2岁)、民族(藏族、汉族),以及居住地海拔高度(分为<4 000 m和≥4 000 m两组)进行1 ∶1病例匹配,病例组与对照组各纳入393例。两组间针对消化性溃疡出血的危险因素(居住地,吸烟,饮酒,服用NSAIDs/抗凝药物,合并HAPC、高血压、糖尿病、心脏病、高脂血症、脑血管病、慢性肺病、关节病等慢性疾病)进行比较分析。结果: 病例组中合并HAPC患者28例(7.1%),对照组为5例(1.3%), 组间差异有统计学意义(OR=5.953,P<0.001)。多因素Logistic回归分析发现HAPC(OR=5.270,95%CI:1.806~15.380)、居住在城镇(OR=2.369,95%CI:1.559~3.602)、饮酒(OR=3.238,95%CI: 1.973~5.317)及服用非甾体抗炎药(non-steroidal anti-inflammatory drugs, NSAIDs)/抗凝药物(OR=20.584,95%CI:2.639~160.545)是我国西藏地区消化性溃疡出血的独立危险因素。在调整了居住在城镇、饮酒、服用NSAIDs/抗凝药物等可能的混杂因素后,HAPC与我国西藏地区消化性溃疡出血风险增加有关(OR=5.270)。结论: 我国西藏地区合并HAPC的患者可显著增加消化性溃疡出血风险。

关键词: 高原红细胞增多症, 消化性溃疡, 出血, 中国西藏

Abstract:

Objective: To explore the relationship between high altitude polycythemia (HAPC) and peptic ulcer bleeding, in order to provide the evidence for the clinical diagnosis and treatment of peptic ulcer disease in Tibet of China. Methods: A retrospective case-control study was conducted. Patients who hospitalized in the Department of Gastroenterology with the diagnosis of peptic ulcer bleeding from January 1, 2015 to April 30, 2021 in Tibet Autonomous Region People’s Hospital were enrolled in the case group, and patients who hospitalized in the Department of Urology without tumor and without the history of peptic ulcer and gastrointestinal bleeding during the same period were selected as the control group. In the study,1 ∶1 case matching was conducted between the two groups according to the gender, age (±2 years), ethnic group (Tibetan, Han), and the residence altitude level (grouped by<4 000 m or ≥4 000 m), and 393 cases were included in the case group and the control group respectively. All the patients had lived in Tibet with the altitude >2 500 m for more than 1 year, and with age ≥ 18 years. The risk factors of peptic ulcer bleeding (place of residence, smoking, alcohol, the use of NSAIDs/anticoagulants, and combined with chronic diseases, such as HAPC, hypertension, diabetes mellitus, heart disease, hyperlipidemia, cerebrovascular disease, chronic lung disease, joint disease) were analyzed and compared between the two groups. Results: There were 28 (7.1%) patients with HAPC in the case group, and 5 (1.3%) in the control group. The incidence of HAPC in the case group was significantly higher than those in the control group, P<0.001, and the OR value was 5.953. Multivariate Logistic regression analysis showed that HAPC (OR=5.270, 95%CI: 1.806-15.380), living in cities and towns (OR=2.369, 95%CI: 1.559-3.602), alcohol (OR=3.238, 95%CI:1.973-5.317) and the use of NSAIDs/anticoagulants (OR=20.584, 95%CI: 2.639-160.545) were the independent risk factors for peptic ulcer bleeding in Tibet. After adjusting for the possible confounding factors, such as living in cities and towns, alcohol, and the use of NSAIDs/anticoagulants, HAPC was associated with an increased risk of peptic ulcer bleeding in Tibet, and the OR value was 5.270. Conclusion: HAPC was associated with a significantly increased risk of peptic ulcer bleeding in Tibet. Patients with HAPC and peptic ulcer should be diagnosed and treated actively, in order to avoid gastrointestinal bleeding and other serious complications.

Key words: High altitude polycythemia, Peptic ulcer, Bleeding, Tibet of China

中图分类号:

R573.2

许颖,次仁央金. 高原红细胞增多症与消化性溃疡出血的关系[J]. 北京大学学报（医学版）, 2022, 54(1): 161-165.

XU Ying, Ci-ren-yang-jin. Analysis of the relationship between high altitude polycythemia and peptic ulcer bleeding[J]. Journal of Peking University (Health Sciences), 2022, 54(1): 161-165.

图/表 3

表1

病例组与对照组一般资料表"

Items	Case group (n=393)	Control group (n=393)
Gender
Male, n(%)	331 (84.2)	331 (84.2)
Female, n(%)	62 (15.8)	62 (15.8)
Age/years, $x ?$ ±s	45.47±15.16	45.59±15.18
Ethnic group
Tibetan, n(%)	353 (89.8)	353 (89.8)
Han, n(%)	40 (10.2)	40 (10.2)
The residence altitude level
<4 000 m, n(%)	316 (80.4)	316 (80.4)
≥4 000 m, n(%)	77 (19.6)	77 (19.6)

表1

表2

表3

参考文献 14

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Items	Case group (n=393)	Control group (n=393)	P
HAPC			<0.001
Yes, n(%)	28 (7.1)	5 (1.3)
No, n(%)	365 (92.9)	388 (98.7)
Place of residence			<0.001
Farming and pastoral areas, n(%)	213 (54.2)	283 (72.0)
Cities and towns, n(%)	180 (45.8)	110 (28.0)
Smoking			<0.001
Yes, n(%)	148 (37.7)	96 (24.4)
No, n(%)	245 (62.3)	297 (75.6)
Alcohol			<0.001
Yes, n(%)	111 (28.2)	46 (11.7)
No, n(%)	282 (71.8)	347 (88.3)
NSAIDs/anticoagulants			<0.001
Yes, n(%)	29 (7.4)	2 (0.5)
No, n(%)	364 (92.6)	391 (99.5)
Combined with other chronic diseases
Hypertension			<0.001
Yes, n(%)	50 (12.7)	56 (14.2)
No, n(%)	343 (87.3)	337 (85.8)
Diabetes mellitus			<0.001
Yes, n(%)	12 (3.1)	17 (4.3)
No, n(%)	381 (96.9)	376 (95.7)
Heart disease			<0.001
Yes, n(%)	12 (3.1)	4 (1.0)
No, n(%)	381 (96.9)	389 (99.0)
Hyperlipidemia			<0.001
Yes, n(%)	10 (2.5)	2 (0.5)
No, n(%)	383 (97.5)	391 (99.5)
Cerebrovascular disease			<0.001
Yes, n(%)	9 (2.3)	1 (0.3)
No, n(%)	384 (97.7)	392 (99.7)
Chronic lung disease			<0.001
Yes, n(%)	7 (1.8)	2 (0.5)
No, n(%)	386 (98.2)	391 (99.5)
Joint disease			<0.001
Yes, n(%)	12 (3.1)	2 (0.5)
No, n(%)	381 (96.9)	391 (99.5)

Items	P	0R	95%CI
HAPC	0.002	5.270	1.806-15.380
Living in cities and towns	<0.001	2.369	1.559-3.602
Smoking	0.111	1.338	0.935-1.916
Alcohol	<0.001	3.238	1.973-5.317
NSAIDs/anticoagulants	0.004	20.584	2.639-160.545
Hypertension	0.072	0.574	0.313-1.050
Diabetes mellitus	0.081	0.404	0.146-1.118
Heart disease	0.216	3.474	0.483-24.998
Hyperlipidemia	0.288	2.415	0.475-12.270
Cerebrovascular disease	0.134	5.533	0.591-51.830
Chronic lung disease	0.983	1.019	0.178-5.817
Joint disease	0.212	2.985	0.536-16.625