目的：探讨抗血小板药物引起非静脉曲张上消化道出血的患者随访期间再出血的危险因素。方法：回顾性收集我院2017年1月至2019年12月抗血小板药物相关性非静脉曲张上消化道出血患者临床资料，根据随访时是否再次发生上消化道出血分为观察组（143例）和对照组（152例）。采用Blatchford评分与AIMS65评分评估患者出血严重程度，通过改良Lanza评分评估胃肠黏膜损伤严重程度，分别比较两组患者临床特征及内镜表现。结果：两组患者年龄、性别、首次入院时血红蛋白量、入院时是否存在失血性休克、合并基础病，Blatchford评分以及AIMS65评分等比较差异均具有统计学意义（P<0.05）。随访期间，上消化道出血平均缓解时间（23.89±1.16）个月，随访3个月累计缓解率0.96±0.04，第15个月累计缓解率0.89±0.07。Cox回归法单因素分析发现，首次入院时血红蛋白量、是否存在休克状态、是否合并基础病以及改良Lanza评分均具有统计学意义（P<0.05）。结论：首次入院时低血红蛋白量、存在休克状态、合并基础病以及胃肠黏膜损伤严重是导致抗血小板药物相关性非静脉曲张上消化道出血患者出院后再次出血的危险因素。

[1] JOHNSTON S C,EASTON J D,FARRANT M,et al.Clopidogrel and Aspirin in acute ischemic stroke and high-risk TIA[J].N Engl J Med,2018,379(3):215-225.
[2] BAIGENT C,BLACKWELL L,COLLINS R,et al.Aspirin in the primary and secondary prevention of vascular disease:collaborative meta-analysis of individual participant data from randomized trial[J].Lancet,2009,373(9678):1849-1860.
[3] KIM S B,LEE S H,KIM K O,et al.Risk factors associated with rebleeding in patients with high risk peptic ulcer bleeding:focusing on the role of second look endoscopy[J].Dig Dis Sci,2016,61(2):517-522.
[4] KOSKINAS K C,RÄBER L,ZANCHIN T,et al.Clinical impact of gastrointestinal bleeding in patients undergoing percutaneous coronary interventions[J].Circ Cardiovasc Interv,2015,8(5):e002053.
[5] 《中华内科杂志》编辑部,《中华医学杂志》编辑部,《中华消化杂志》编辑部,等.急性非静脉曲张性上消化道出血诊治指南(2018年,杭州)[J].中华消化杂志,2019,36(2):77-85.
[6] 伍国顺.Glasgow-Blatchford和AIMS65评分系统在急性消化道出血患者预后评估中的价值[J].中国内镜杂志,2016,22(4):71-76.
[7] SHOTARO N,TAKAYUKI M,HIROSHI S,et al.Emergency endoscopy for acute gastrointestinal bleeding:prognostic value of endoscopic hemostasis and the AIMS65 score in Japanese patients[J].Dig Endosc,2014,26(3):369-376.
[8] LANZA F L,GRAHAM D Y,DAVIS R E,et al.Endoscopic comparison of cimetidine and sucralfate for prevention of naproxen-induced acute gastroduodenal injury[J].Dig Dis Sci,1990,35(12):1494-1499.
[9] GOUYA G,ARRICH J,WOLZT M,et al.Antiplatelet treatment for prevention of cerebrovascular events in patients with vascular diseases:a systematic review and meta-analysis[J].Stroke,2014,45(2):492-503.
[10] CROOKS C J,WEST J,CARD T R.Comorbidities affect risk of nonvariceal upper gastrointestinal bleeding[J].Gastroenterology,2013,144(7):1384-1393.
[11] LI L,GERAGHTY O C,MEHTA Z,et al.Age-specific risks,severity,time course,and outcome of bleeding on long-term antiplatelet treatment after vascular events:a population-based cohort study[J].Lancet,2017,390(10093):490-499.
[12] 郭俊芝,姜丽君.抗血小板药物相关非静脉曲张上消化道出血的临床特征及影响因素[J].山西医科大学学报,2018,308(6):70-75.
[13] VALKHOFF V E,STURKENBOOM M C,KUIPERS E J.Risk factors for gastrointestinal bleeding associated with low-dose aspirin[J].Best Pract Res Clin Gastroenterol,2012,26(2):125-140.
[14] JUNG D H,KO B S,KIM Y J,et al.Comparison of risk scores and shock index in hemodynamically stable patients presenting to the emergency department with nonvariceal upper gastrointestinal bleeding[J].Eur J Gastroenterol Hepatol,2019,31(7):781-785.
[15] TANTAI X X,LIU N,YANG L B,et al.Prognostic value of risk scoring systems for cirrhotic patients with variceal bleeding[J].World J Gastroenterol,2019,25(45):6668-6680.
[16] 陈宗衔.上消化道出血内镜治疗后再出血的危险因素分析[J].中国卫生统计,2014,31(6):999-1000.
[17] SUEHIRO T,YAKEISHI Y,SAKAI F,et al.Gastrointestinal bleeding associated with antithrombotic therapy in the elderly in Japan[J].Hepatogastroenterology,2012,59(115):774-777.
[18] DUNNE P D,LAURSEN S B,LAINE L,et al.Previous use of anti-thrombotic agents reduces mortality and length of hospital stay in patients with high-risk upper gastrointestinal bleeding[J].Clin Gastrornterol H,2019,17(3):440-447.
[19] 雷蕾,李良平,李琴.中老年男性人群长期口服抗凝药物后的胃镜随访结果[J].中国内镜杂志,2016,22(1):53-57.
[20] 夏志伟,马琳琳,姚炜.非甾体消炎药及阿司匹林相关消化性溃疡出血住院患者的实时调查[J].中华内科杂志,2011,50(2):111-115.
[21] 李秋元,陈杰武,李郁声.使用非甾体抗炎药导致的上消化道出血回顾性分析[J].河北医药,2011,33(14):2152-2154.
[22] 杨湛南,方文,黄茜.幽门螺杆菌感染对冠心病患者抗血小板治疗后上消化道出血的影响[J].贵州医科大学学报,2017,42(9):1050-1054
[23] HUANG E S,STRATE L L,HO W W,et al.Long-term use of aspirin and the risk of gastrointestinal bleeding[J].Am J Med,2011,124(5):426-433.