Krvareći gastroduodenalni ulkusi kod bolesnika bez Helicobacter pylori infekcije i bez upotrebe nesteroidnih antiinflamatornih lekova

  • Brigita Smolović Clinical Center of Montenegro, Faculty of Medicine, University of Montenegro, Podgorica, Montenegro
  • Dejana Stanisavljević Institute of Medical Statistics, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
  • Mileta Golubović Clinical Center of Montenegro, Faculty of Medicine, University of Montenegro, Podgorica, Montenegro
  • Ljiljana Vučković Clinical Center of Montenegro, Faculty of Medicine, University of Montenegro, Podgorica, Montenegro
  • Biljana Miličić Institute of Medical Statistics, Faculty of Dental Medicine, University of Belgrade, Belgrade, Serbia
  • Srdjan Djuranović Clinic for Gastroenterology, Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
DOI: https://doi.org/10.2298/2844
Ključne reči: peptic ulcer hemorrhage||, ||peptički ulkus, krvarenje, helicobacter pylori||, ||helicobacter pylori, anti-inflammatory agents, non-steroidal||, ||antiinflamatorici, nesteroidni, risk factors||, ||faktori rizika,

Sažetak


Uvod/Cilj. Visoki rizik od krvarenja Helicobacter pylori (H. pylori)-negativnih i sa nesteroidnim inflamatornim lekovima (NSAIL)-negativnih ulkusa potencirao je klinički značaj analiziranja novih tendencija peptičke ulkusne bolesti. Cilj ove studije bio je ispitati faktore rizika od nastanka krvarećeg ulkusa kod bolesnika bez H. pylori infekcije i bez upotrebe NSAIL. Metode. Prospektivna studija obuhvatala je bolesnike sa endoskopski dijagnostikovanom ulkusnom bolešću. Bolesnici su bili bez H. pylori infekcije (potvrđeno patohistološki i serološki) i bez upotrebe NSAIL i inhibitora protonske pumpe (IPP) tokom četiri nedelje pre endoskopije. Posle endoskopije bolesnici su bili podeljeni u dve grupe: studijsku grupu od 48 bolesnika sa krvarećim ulkusom i kontrolnu grupu od 47 bolesnika sa ulkusom bez krvarenja. Pre endoskopije bolesnici su popunjavali upitnik o demografskim podacima, faktorima rizika i navikama. Funkcija trombocita, von Willebrand faktor (vWF) i krvne grupe ispitivane su, takođe. Patohistološki su analizirani biopsijski uzorci po modifikovanom Sydnejskom sistemu. Uticaj bilijarnog refluksa analiziran je pomoću bilijarnog refluksnog indeksa (BRI). Rezultati. Godine, pol, pušenje i upotreba alkohola nisu imali uticaj na stopu krvarenja. Rizik od krvarenja nije zavisio od udruženih bolesti (p = 0,509), niti od izloženosti stresu (p = 0,944). Aspirin je uzimalo 16/48 (33,3%) bolesnika sa krvarećim ulkusom, u poredeđenju sa 7/47 (14.9%) bolesnika koji nisu krvarili (p = 0,036). Abnormalnu funkciju trombocita imalo je 12/48 (25,0%) bolesnika sa krvarenjem, u poređenju sa 2/47 (4,3%) bolesnika koji nisu krvarili (p = 0,004). Bolesnici sa BRI < 14 krvarili su u 79,2%, a nisu krvarili u 57,4% slučajeva (p = 0,023). Nije bilo statistički značajne razlike između dve grupe u odnosu na krvne grupe i nivo vWF. Antralna atrofija nađena je kod 14/48 (29,2%) bolesnika sa krvarećim ulkusom i kod 5/47 (10,6%) bolesnika koji su imali ulkus bez krvarenja (p = 0,024).  Zaključak. Abnormalna funkcija trombocita, upotreba aspirina i antralna atrofija jesu faktori rizika od krvarenja kod H. pylori-negativne i NSAIL-negativne ulkusne bolesti.

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Objavljeno
2015/04/21
Broj časopisa
Vol. 71 Br. 2 (2014)
Rubrika
Originalni članak