年長女性使用低劑量Aspirin相關消化性潰瘍風險較高
作者：Laurie Barclay, MD
出處：WebMD醫學新聞
April 28, 2010 — 根據一項發表於4月21日世界腸胃醫學期刊的研究結果，年長女性使用低劑量Aspirin（LDA）相關的消化性潰瘍風險較高。
日本平塚市立醫院的Kazuhisa Okada與其同事們寫到，LDA是用於預防栓塞血管事件一個主要藥物，且具有低價與抑制血小板作用較長的好處；然而，這與腸胃道出血風險加倍有關，即使劑量只有每天75 mg。性別差異對於LDA相關胃、十二指腸黏膜損傷臨床表徵的差異，目前並不清楚。這項研究的主要目的在於釐清男女性LDA相關胃、十二指腸黏膜損傷的臨床特徵與危險因子。
在2003年1月到2007年12月，總共有453位病患（298位男性、155位女性）接受LDA治療（每天81-100 mg），且在平塚市立醫院接受食道、胃、十二指腸內視鏡檢查，在整個觀察期持續使用LDA。其中119位患者（87位男性、32位女性）被診斷罹患LDA相關消化性潰瘍。
不論男性、女性，過去有潰瘍病史是LDA相關消化性潰瘍的一個危險因子。另一個顯著的危險因子是年齡大於70歲，但僅限於女性，在男性並非如此（盛行率勝算比為8.441；95%信賴區間為1.797-33.649；P=0.0069）。相較於男性病患，女性病患由內視鏡診斷為LDA相關消化性潰瘍的時間顯著較短。
研究作者們寫到，我們展示LDA相關消化性潰瘍的臨床特徵與危險因子在性別上的差異。應該要特別注意正在使用LDA的年長女性。
這項研究的限制包括觀察性設計。
研究作者們的結論是，對年長女性而言，停經後隨著年齡增長，女性荷爾蒙濃度逐漸下降，加上腸胃道黏膜抵抗力的下降，都可能造成LDA相關消化性潰瘍風險增加。
Risk for Low-Dose Aspirin-Associated Peptic Ulcer Higher in Elderly Women
By Laurie Barclay, MD
Medscape Medical News
April 28, 2010 — The risk for low-dose aspirin (LDA)–associated peptic ulcer is higher in elderly women, according to the results of a study reported in the April 21 issue of World Journal of Gastroenterology.
"...LDA is one of the main agents used for the prevention of thromboembolic vascular events, and has the advantages of both low cost and a prolonged duration of antiplatelet action; however, it is associated with a doubling of the risk of gastrointestinal bleeding, even at doses as low as 75 mg daily," write Kazuhisa Okada, from Hiratsuka City Hospital in Hiratsuka, Japan, and colleagues. "The gender differences in the clinical manifestations of LDA-associated gastroduodenal mucosal injury have not been well studied. The aim of this study was to clarify the clinical features and risk factors of LDA-associated gastroduodenal mucosal injury in both sexes."
Between January 2003 and December 2007, a total of 453 patients (298 men and 155 women) being treated with LDA (81 - 100 mg daily) underwent esophagogastroduodenoscopy at Hiratsuka City Hospital and continued taking LDA during the entire observation period. LDA-associated peptic ulcer was diagnosed in 119 patients (87 men and 32 women).
In both sexes, a history of peptic ulcer was a risk factor for LDA-associated peptic ulcer. Another significant risk factor in women, but not in men, was age older than 70 years (prevalence odds ratios, 8.441; 95% confidence interval, 1.797 - 33.649; P = .0069). Compared with male patients, female patients had a significantly shorter time to diagnosis of LDA-associated peptic ulcer by endoscopy (P = .0050).
"We demonstrated gender differences about the clinical features and risk factors of LDA-associated peptic ulcer," the study authors write. "Special attention should be paid to aged female patients taking LDA."
Limitations of this study include observational design.
"In female patients of advanced age, the gradual decrease in the serum levels of female sex hormones after menopause and with advancing age, coupled with the reduced gastric mucosal defenses may be responsible for the increase in the risk of LDA-associated peptic ulcer," the study authors conclude.
World J Gastroenterol. 2010;16:1896-1900.
