The use of adrenocortical hormone (hormone) and aspirin on primary nephrotic syndrome of digestive tract hemorrhage patients. Methods 167 cases of primary nephrotic syndrome patients: a case-control study. According to the medication were pided into single hormone group, combined treatment group and control group. Results in 16 patients hemorrhage of digestive tract. In the multivariate Logistic regression model, and the control group, single risk is not hormone gastrointestinal bleeding factors, and hormone combined with aspirin can increase gastrointestinal bleeding in 104.9% (95% CI 1.431-2.682). Conclusions for patients with primary nephrotic syndrome, the use of hormone is not risk factors of hemorrhage of digestive tract alone, but in combination with aspirin can significantly increase the risk of gastrointestinal bleeding.
Glucocorticoid (hereinafter referred to as the hormone) is the main drug in primary nephrotic syndrome. The traditional view is that the hormone may damage the gastric mucosa. Aspirin is a commonly used non steroidal anti-inflammatory drugs (NSAIDs), used in combination with hormone may further aggravate the injury of gastric mucosa, and upper gastrointestinal bleeding. In patients with primary nephrotic syndrome, study the relationship between the use of hormone and aspirin and gastrointestinal bleeding. First, objects and methods in our hospital from January 2005 to January 2011 between the primary nephrotic syndrome hospitalized cases were studied retrospectively. The object of study: (1) with nephrotic syndrome syndrome diagnostic criteria, namely urine protein and serum albumin was 3.5g/24h = 30g/L; (2) by renal biopsy and etiological diagnosis, clinical manifestations and laboratory examination Check, not found these cases cause secondary factors of nephrotic syndrome; (3) hormone usage is 1mg/kg/d or prednisone Medrol 0.8mg/kg/d treatment lasted for 8 weeks; aspirin dosage for 100mg/d; (4) at least every 2 weeks to check 1 fecal occult blood test, continuous observation for at least 8 weeks; (5) the following cases: exclusion of anemia in patients with oral iron; the effect of hemostasis coagulation - taking other drugs, including warfarin, Pan Shengding and cilostazol; the observation period using other NSAIDs drugs other than aspirin. Group: according to the inclusion of medicine were pided into three groups: single hormone group: administered alone the hormone; combined treatment group: hormone combined with aspirin; the control group: the hormone is less than or equal to 10mg/d and no use of aspirin. The definition of observed for end point Gastrointestinal bleeding. Definition of fecal occult blood test positive for occult bleeding; vomiting or black stool defined as overt bleeding; if the amount of bleeding, vomiting, bleeding or hemoglobin decreased more than 10g/L, or the loop is not stable, or need a blood transfusion for bleeding. The results of measurement data expressed by the mean and standard deviation analysis of variance, independent sample comparison between group differences. Count data expressed by the number of cases, 2 were analysis or Fisher exact probability method to compare the differences between groups. Multivariate Logistic regression analysis was used to analyze the risk factors of digestive tract hemorrhage, select the univariate analysis results P < 0.10 variables selected model, calculation of digestive tract the risk of bleeding odds ratio (OR value) and 95% confidence intervals (95%CI). Statistical analysis was performed using SPSS 13 software package, P < 0.05 for the definition of bilateral differences between groups was statistically significant. Two, the general situation of the 1. research objects were collected to meet the requirements of the 167 cases, cause of nephrotic syndrome is minimal change disease (cases), focal segmental glomerulosclerosis (cases), mesangial proliferative glomerulonephritis and IgA nephropathy (cases) and membranous nephropathy (cases). The use of hormones or hormone combined with aspirin in the treatment of inpidual patients were 105 cases and 42 cases. The combined use of aspirin are the primary prevention.20 coronary heart disease in two cases as the control object, idiopathic membranous nephropathy patients and 11 cases of serum creatinine values less than or equal to 133 mu mol/L, 9 cases of small dose hormone (prednisone 10mg/d) primary FSGS patients combined with cyclosporin A therapy. Patients generally see table 1.
2. gastrointestinal bleeding in 16 patients after the use of hormone 42 + 12 days found gastrointestinal bleeding, no bleeding occurred. All with digestive tract hemorrhage observation object were given a proton pump inhibitor treatment, auxiliary gastric mucosal protective agents, clinical recovery after treatment, follow-up period without analysis of bleeding again. 3. gastrointestinal bleeding risk factors of 2 shows the univariate risk factors of gastrointestinal bleeding: analysis results and non gastrointestinal bleeding patients, age, gender, smoking and level of proteinuria with no statistically significant difference; and there is no gastrointestinal tract hemorrhage were compared, gastrointestinal bleeding patients for more the combination of the patients (50%), but no statistically significant difference (P=0.053). Further, the univariate analysis of P < 0.10 variables in multivariate Logistic regression Analysis in the model is analyzed. The results showed that high eGFR value and preventive treatment of protecting stomach were protective factors of gastrointestinal bleeding, past history of gastrointestinal disease is a risk factor for bleeding. Compared with the control group, single risk is not hormone gastrointestinal bleeding factors, and hormone combined with aspirin can increase gastrointestinal bleeding the probability of more than 1 times. Table 2: univariate analysis of risk factors of digestive tract hemorrhage
Comparison of occurrence of the risk of gastrointestinal bleeding and three in control group, discuss the hormone is the treatment of rheumatic diseases and nephrotic syndrome commonly used drugs. Generally, hormone injury of gastric mucosa, can cause peptic ulcer, and even induce gastrointestinal bleeding. But the Conn challenge of  on this point of view; Messer the change of the object of Conn research and statistical methods, still think that hormones can lead to study . the two opposite conclusion gastric ulcer have been published in the new England Journal of Medicine Authority < >. For the controversial methods on local Conn, again in 1994 of 93 randomized controlled clinical study again the Meta analysis included a total of 6602 cases, the results showed the placebo control group and hormone treatment rates were 0.3% and 0.4% groups of gastric ulcer, with no statistical difference between . note Is that the research results on hormone therapy for rheumatic diseases. These results from patients with rheumatic diseases often use a combination of NSAIDs drugs. The combined use of non selective NSAIDs based on hormone application, gastric ulcer incidence may increase 462%. in nephrotic syndrome with hypoproteinemia and edema in patients with renal function characteristics. Not all, these factors may be involved in the digestive tract injury. Therefore, hormone induced gastric ulcer, results of gastrointestinal bleeding and can not be directly extended to the field of nephrotic syndrome. Aspirin is clinically a non selective NSAIDs. widely used recently in the understanding that diabetes is a great risk of coronary heart disease in diabetic patients, promote early the two grade prevention of coronary heart disease using aspirin. Therefore, patients with aspirin in nephrotic syndrome increased. Two pre for coronary heart disease The dose of aspirin is less than the anti rheumatic disease, this dose hormone would increase in patients with nephrotic syndrome of gastric ulcer and gastrointestinal bleeding risk, there is a lack of research. In this study, univariate analysis showed that renal dysfunction and gastrointestinal diseases history is the risk of digestive tract hemorrhage factors, and protecting stomach treatment is a protective factor; but the use of hormones, hormone combined with aspirin and control group overall between gastrointestinal bleeding had no significant difference (P=0.053). This may be the small sample size and the single variable model does not consider the other interference factors. Further multivariate model showed that hormone combined with aspirin can increase the risk of digestive tract 104.9% bleeding, tips based on hormone application, at the same time, the use of aspirin may still lead to gastric mucosal injury. However, compared with the control group, single Do not use hormone digestive tract hemorrhage risk factors. This result and a recent study conducted by researchers in Taiwan are: not using NSAIDs in patients with nephrotic syndrome, hormone (60mg daily) in treatment of gastric ulcer in March did not increase . in this paper has the following limitations: (1) a small retrospective study. The results also need more prospective data to verify (2). In addition, in order to exclude the interference factors of the established criteria. Therefore, it is not suitable for the analysis of exclusion criteria in the crowd. In summary, for patients with primary nephrotic syndrome, risk factors of gastrointestinal bleeding is not hormone alone. But aspirin can significantly increase the risk of gastrointestinal bleeding.