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幽门螺杆菌阴性的特发性出血性溃疡患者的高死亡率和高再出血率 |
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High Incidence of Mortality and Recurrent Bleeding in Patients With Helicobacter pylori-Negative Idiopathic Bleeding Ulcers |
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Wong GL, Wong VW, Chan Y, Ching JY, Au K, Hui AJ, Lai LH, Chow DK, Siu DK, Lui Y, Wu JC, To K, Hung LC, Chan HL, Sung JJ, Chan FK 2009/8/4 15:32:00 |
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Gastroenterology, 2009, Volume 137, Issue 2
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Background & Aims: The long-term prognosis of peptic ulcers associated with neither Helicobacter pylori nor nonsteroidal anti-inflammatory drugs (NSAIDs) is unknown. Methods: This 7-year prospective cohort study recruited patients with bleeding ulcers from January to December 2000. H pylori-negative idiopathic bleeding ulcers were defined as having tested negative for H pylori, having no exposure to aspirin or analgesics within 4 weeks before endoscopy, and having no other identifiable causative factors. After ulcers healed, patients were divided into 2 groups: patients with prior H pylori-negative idiopathic bleeding ulcers (H pylori-negative idiopathic ulcer cohort; n = 120) and those with H pylori-positive, NSAID-negative bleeding ulcers who received eradication therapy (H pylori ulcer cohort; n = 213). Both groups were followed for ≤7 years without gastroprotective therapy. The primary endpoints were recurrent ulcer bleeding and mortality. Results: The 7-year cumulative incidence of recurrent ulcer bleeding was 42.3% (95% CI, 36.5%-48.1%) in the H pylori-negative idiopathic ulcer cohort and 11.2% (95% CI, 8.8%-13.6%) in the H pylori ulcer cohort (a difference of 31.1%; 95% CI, 27.7%-34.5%; P < .0001). Significantly more patients died in the H pylori-negative idiopathic ulcer cohort (87.6%; 95% CI, 83.0%-92.2%) than in the H pylori ulcer cohort (37.3%; 95% CI, 34.0%-40.6%) with a difference of 50.3% (95% CI, 49.0%-51.6%; P < .0001). Conclusions: Patients with history of H pylori-negative idiopathic bleeding ulcers have a high risk of recurrent ulcer bleeding and mortality. © 2009 AGA Institute.
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Correspondence Address: Chan, F.K.; Institute of Digestive Disease, The Chinese University of Hong Kong ; Hong Kong SAR, China; email:fklchan@cuhk.edu.hk |
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疾病资源中心
摘自:《西氏内科学》,第23版
患者女性,21岁,因干咳、间歇性气促2个月到急诊科就诊。开始症状为上呼吸道感染引起的鼻塞、流涕和咳嗽。医生检查后开了抗生素。服药后鼻部症状缓解,但仍有轻微干咳和呼吸困难。其他症状包括疲劳和焦虑。否认发热、体重减轻、胸痛、端坐呼吸、气喘、鼻后滴漏、胃灼热以及神经系统症状。
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