| Background : Aspirin is the most widely used medicine since its introduction in 1898.It is the most effective antiplatelet drug in evidence-based medicine and low dose aspirin(LDA)has became the most basic drug for the primary and secondary prevention of cardiovascular and cerebrovascular diseases.However,the side effects of the gastrointestinal tract have attracted more and more attentions.Studies showed that even LDA can significantly increase the risk of upper gastrointestinal ulcer bleeding to 3.7 times.Although many risk factors of aspirin related gastrointestinal mucosal injury have been confirmed,such as age,previous history of gastrointestinal tract hemorrhage,recent study found that up to 60% patients of aspirin-or other nonsteroidal anti-inflammatory drugs-induced gastrointestinal bleeding did not belong to the traditional high-risk group.Then to search new predictors of aspirin-related gastrointestinal mucosal injury in traditional average-risk group is of great clinical significance.High gastric acid secretion and Helicobacter pylori(Hp)infection are the causes of peptic ulcer,but whether they are also related to the aspirin-induced gastrointestinal mucosal injury are still lack of evidences.As pepsinogen(PG)and gastrin17(G17)can reflect gastric acid secretion,our study intends to investigate the relationship between serum levels of PG,G17 and Hp infection status with aspirin-related gastrointestinal mucosal injury,then to determine whether those indicators can be used for the prediction of aspirin-related gastrointestinal mucosal injury.Objective: To investigate the role of serum PG,G17 level and Hp infection status in predicting the aspirin-related gastrointestinal mucosal injury and provide a feasible andeffective strategy to identify high-risk group of aspirin-related gastrointestinal mucosal injury and guide the PPI individualized preventive treatment.Method: Patients with long term use of low dose aspirin for at least 1 months were included in this study;serum PG I,PG II and G17 were detected by enzyme-linked immunosorbent assay(ELISA);Helicobacter pylori infection was detected by 14 C breath test;gastrointestinal mucosal injury was scored by improved LANZA rating scale during gastroscope.Results: A total of 60 patients were entrolled.15 of them belonged to severe gastrointestinal mucosal injury group(SGI).The serum level of PG I was significantly higher in patients with SGI group than in mild gastrointestinal mucosal injury groups(MGI)(156.9 ? 39.1 VS.118.1 ? 46.6ng/ml,P<0.05).The infection rate of Helicobacter pylori was significantly higher in SGI group than MGI group(73% VS.40%,P=0.03).Both PG II and G17 level shown no significant differences between two groups.ROC curve shown the cutoff value of PG I was 123ng/ml(sensitivity 80%,specificity 61.4%).Helicobacter pylori infection combined with PG I ≥ 123ng/ml predicted the risk of aspirin related gastrointestinal mucosal injury to 15.8 fold(95%CI,24 ? 104.5).The positive predictive value of Hp combined with HPGI in aspirin related gastrointestinal mucosal damage was 90%,negative predictive value was 76%,positive likelihood ratio was 10,negative likelihood ratio was 0.3,sensitivity of 69%,specificity of 93%,accuracy of 81%.Through Univariate and multivariable analysis for the risk factors of aspirin-induced gastroduodenal injury,we found that that sex,age,smoking history,drinking history,PG II and G17 PG I were not the independent risk factors for gastrointestinal injury caused by aspirin.But PG I and Hp infection were the independent risk factors for aspirin-induced gastroduodenal injury(P<0.05).Conclusion: Serum PG Iand Helicobacter pylori infection can be used to identify high-risk group of aspirin-related gastrointestinal mucosal injury and to guide the PPI individualized preventive treatment. |
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