切换至 "中华医学电子期刊资源库"

中华胃肠内镜电子杂志 ›› 2025, Vol. 12 ›› Issue (01) : 54 -57. doi: 10.3877/cma.j.issn.2095-7157.2025.01.012

综述

慢性肾脏病并发上消化道出血的研究进展
赵秋灵1, 李红平2, 文皓1, 周微薇1, 罗宇1, 何朝晖1,()   
  1. 1. 519000 珠海,遵义医科大学第五附属(珠海)医院消化内科
    2. 563000 遵义,遵义医科大学附属医院消化病医院,遵义医科大学附属医院消化内科
  • 收稿日期:2024-10-19 出版日期:2025-02-15
  • 通信作者: 何朝晖
  • 基金资助:
    广东省医学会临床科研专项基金(2024HY-B5017)

Research progress of upper gastrointestinal bleeding in chronic kidney disease

Qiuling Zhao1, Hongping Li2, Hao Wen1, Weiwei Zhou1, Yu Luo1, Zhaohui He1,()   

  1. 1. Department of Gastroenterology,The Fifth Affiliated Hospital of Zunyi Medical University (Zhuhai), Zhuhai 519000, China
    2. Department of Gastroenterology,Digestive Disease Hospital,Affiliated Hospital of Zunyi Medical University,Zunyi 563000,China
  • Received:2024-10-19 Published:2025-02-15
  • Corresponding author: Zhaohui He
引用本文:

赵秋灵, 李红平, 文皓, 周微薇, 罗宇, 何朝晖. 慢性肾脏病并发上消化道出血的研究进展[J/OL]. 中华胃肠内镜电子杂志, 2025, 12(01): 54-57.

Qiuling Zhao, Hongping Li, Hao Wen, Weiwei Zhou, Yu Luo, Zhaohui He. Research progress of upper gastrointestinal bleeding in chronic kidney disease[J/OL]. Chinese Journal of Gastrointestinal Endoscopy(Electronic Edition), 2025, 12(01): 54-57.

慢性肾脏疾病(CKD)是全球性公共卫生问题,流行病学研究表明,CKD 在普通人群中的患病率正在增加。 上消化道出血(UGIB)是CKD 最常见的并发症之一,同时CKD 又是上消化道出血的独立预测因子。 慢性肾脏病患者中上消化道出血的发生率、死亡率、再出血率较高。 目前导致慢性肾脏病患者上消化道出血的机制尚不清楚,现认为与尿毒症毒素的积累、血小板功能障碍、胃肠道激素的增多、胃肠功能障碍、透析过程中抗凝药物的使用等有关。 本文通过总结近年来国内外针对慢性肾脏病合并上消化道出血的研究进展,从病因、发病机制、治疗、预防等方面进行综述,以便临床医师了解此种疾病,达到早期诊断、专业治疗的目的。

Chronic kidney disease ( CKD ) is a global public health problem.Epidemiological studies have shown that the prevalence of CKD in the general population is increasing.Upper gastrointestinal bleeding ( UGIB ) is the most common complication of CKD,and CKD is an independent predictor of upper gastrointestinal bleeding.The incidence,mortality and rebleeding rate of upper gastrointestinal bleeding in patients with chronic kidney disease are higher.At present,the mechanism of upper gastrointestinal bleeding in patients with chronic kidney disease is not clear,but it is generally believed to be related to the accumulation of uremic toxins,platelet dysfunction,increased gastrointestinal hormones,gastrointestinal dysfunction,and the use of anticoagulant drugs during dialysis.Patients with end-stage renal disease have more underlying diseases and late complications.This article summarizes the research progress of chronic kidney disease complicated with upper gastrointestinal bleeding at home and abroad in recent years,and summarizes the pathogenesis,etiology,treatment,prevention and other aspects,so that clinicians can understand this disease and achieve the purpose of early diagnosis and professional treatment.

[1]
Costa-Moreira P,Vilas-Boas F,Teixeira Fraga A,et al.Particular aspects of gastroenterological disorders in chronic kidney disease and end-stage renal disease patients:a clinically focused review[J].Scand J Gastroenterol,2020,55(2):129-138.
[2]
Kalman RS,Pedrosa MC.Evidence-based review of gastrointestinal bleeding in the chronic kidney disease patient[J].Semin Dial,2015,28(1): 68-74.
[3]
Lin Y,Li C,Waters D,et al.Gastrointestinal bleeding in chronic kidney disease patients:a systematic review and meta-analysis[J].Ren Fail,2023,45(2):2276908.
[4]
Hágendorn R,Farkas N,Vincze á,et al.Chronic kidney disease severely deteriorates the outcome of gastrointestinal bleeding:A meta-analysis[J].World J Gastroenterol,2017,23(47):8415-8425.
[5]
García Agudo R,Aoufi Rabih S,González Carro P,et al.Lesiones gastrointestinales en pacientes con enfermedad renal crónicay anemia[J].Nefrología,2019,39(1):50-57.
[6]
Parasa S,Navaneethan U,Sridhar AR,et al.End-stage renal disease is associated with worse outcomes in hospitalized patients with peptic ulcer bleeding[J].Gastrointest Endosc,2013,77(4):609-616.
[7]
Kim M,Kim CS,Bae EH,et al.Risk factors for peptic ulcer disease in patients with end-stage renal disease receiving dialysis[J].Kidney Res Clin Pract,2019,38(1):81-89.
[8]
吕昂,吴鹏波,谭诗云.合并慢性肾脏病的消化性溃疡患者的临床及胃镜下特征分析[J].医学研究杂志,2022,51(3):24-27.
[9]
Verma S,Attallah MA,Jarrin Jara MD,et al.Angiodysplasia in Renal Disease Patients:Analysis of Risk Factors and Approach to Manage Such Patients[J].Cureus,2020,12(8):e9784.
[10]
Zajjari YTM,Montasser D,Hassani K,et al.Gastrointestinal bleeding due to angiodysplasia in patients on hemodialysis:A single-center study[J].Saudi J Kidney Dis Transpl,2016,27(4):748-751.
[11]
Hung HJ,Chung CS,Tai CM,et al.Clinical characteristics and risk factors for rebleeding in uremic patients with obscure gastrointestinal bleeding undergoing deep enteroscopy:A multicenter retrospective study in Taiwan[J].PLoS One,2022,17(11): e0277434.
[12]
Yuste C,Mérida E,Hernández E,et al.Gastrointestinal complications induced by sevelamer crystals[J].Clin Kidney J,2017,10(4):539-544.
[13]
Rysz J,Franczyk B,Ławiński J,et al.The Impact of CKD on Uremic Toxins and Gut Microbiota[J].Toxins,2021,13(4):252.
[14]
Lutz J,Menke J,Sollinger D,et al.Haemostasis in chronic kidney disease[J].Nephrol Dial Transplant,2014,29(1):29-40.
[15]
Georgopoulou GA,Papasotiriou M,Bosgana P,et al.Altered Expression of Intestinal Tight Junctions in Patients with Chronic Kidney Disease: A Pathogenetic Mechanism of Intestinal Hyperpermeability[J].Biomedicines,2024,12(2):368.
[16]
Paronen I,Ala-Kaila K,Rantala I,et al.Gastric parietal,chief,and G-cell densities in chronic renal failure [J].Scand J Gastroenterol,1991,26(7):696-700.
[17]
王曾,张阳,王琴,等.肾性贫血并发症的研究进展[J].中国血液净化,2022,21(7):469-472.
[18]
Huang CH,Chao JY,Ling TC,et al.Effect of dialysis modalities on risk of hospitalization for gastrointestinal bleeding[J].Sci Rep,2023,13(1):52.
[19]
Thekkedath UR,Chirananthavat T,Leypoldt JK,et al.Elevated fibrinogen fragment levels in uremic plasma inhibit platelet function and expression of glycoprotein IIb-Ⅲa [J].Am J Hematol,2006,81(12):915-926.
[20]
Yaoi H,Shida Y,Ogiwara K,et al.Role of red blood cells in the anemia-associated bleeding under high shear conditions[J].Haemophilia,2017,23(5):750-758.
[21]
Galanopoulos G.Angiodysplastic lesions as a cause of colonic bleeding in patients with chronic renal disease: is there an association? [J].Saudi J Kidney Dis Transpl,2012,23(5):925-928.
[22]
Nambiar S,Pillai UK,Devasahayam J,et al.Colonic Mucosal Ulceration and Gastrointestinal Bleeding Associated with Sevelamer Crystal Deposition in a Patient with End Stage Renal Disease[J].Case Rep Nephrol,2018,2018: 4708068.
[23]
Kim DB,Chung WC,Lee SJ,et al.Analysis of risk factor and clinical characteristics of angiodysplasia presenting as upper gastrointestinal bleeding[J].Korean J Intern Med,2016,31(4):669-677.
[24]
Chen C,Liu L,Wang CY,et al.A pilot study of ultrasound evaluation of gastric emptying in patients with end-stage renal failure:a comparison with healthy controls[J].Anaesthesia,2017,72(6):714- 718.
[25]
Sharma S,Raman P,Deo AS.Comparative preoperative sonological assessment of gastric contents in patients with chronic kidney disease versus those with normal renal function - A prospective observational study[J].Indian J Anaesth,2023,67(6):503-508.
[26]
贾宁,唐艳萍,李杨.现代医学对胃食管反流病研究机制进展[J].中国中西医结合外科杂志,2020,26(1):179-183.
[27]
Costa-Moreira P,Vilas-Boas F,Teixeira Fraga A,et al.Particular aspects of gastroenterological disorders in chronic kidney disease and end-stage renal disease patients:a clinically focused review[J].Scand J Gastroenterol,2020,55(2):129-138.
[28]
Saheb Sharif-Askari F,Syed Sulaiman SA,Saheb Sharif-Askari N.Anticoagulation Therapy in Patients with Chronic Kidney Disease [J].Adv Exp Med Biol,2017,906: 101-114.
[29]
Chan CT,Chang SS,Yeh EK,et al.Upper gastrointestinal bleeding in an end-stage renal disease patient treated with fluoxetine[J].Gen Hosp Psychiatry,2011,33(5):530-531,e533.
[30]
Marinescu DLM,Zaharie S,Comanescu C,et al.Upper Gastrointestinal Bleeding in Chronic Kidney Disease Patients[J].Curr Health Sci J,2016,42(3):226-230.
[31]
殷宝存,付泽鹏,陈君玉.艾司奥美拉唑治疗尿毒症并发上消化道出血的临床有效性及安全性分析[J].现代诊断与治疗,2023,34(15): 2238-2241.
[32]
Qiu Z,Pang X,Xiang Q,et al.The Crosstalk between Nephropathy and Coagulation Disorder:Pathogenesis,Treatment,and Dilemmas[J].J Am Soc Nephrol,2023,34(11):1793-1811.
[33]
王丽红,韩彬.质子泵抑制剂对慢性肾脏病患者上消化道出血临床效果的Meta 分析[J].系统医学,2024,9(3):1-7.
[34]
Desbuissons G,Mercadal L.Use of proton pump inhibitors in dialysis patients:a double-edged sword? [J].J Nephrol,2021,34(3): 661-672.
[35]
Borawski B,Malyszko JS,Kwiatkowska M,et al.Current Status of Renal Anemia Pharmacotherapy-What Can We Offer Today[J].J Clin Med,2021,10(18) : 4149.
[36]
Nair S,Trivedi M.Anemia management in dialysis patients:a PIVOT and a new path? [J].Curr Opin Nephrol Hypertens,2020,29(3): 351-355.
[37]
Wang B,Yin Q,Han YC,et al.Effect of hypoxia-inducible factorprolyl hydroxylase inhibitors on anemia in patients with CKD:a meta-analysis of randomized controlled trials including 2804 patients [J].Renal Failure,2020,42(1):912-925.
[38]
Asai M,Kumakura S,Kikuchi M.Review of the efficacy of AST-120 (KREMEZIN®) on renal function in chronic kidney disease patients[J].Ren Fail,2019,41(1):47-56.
[39]
Chou CY,Wang SM,Chang PH,et al.Angiotensin II receptor blocker prevents upper gastrointestinal bleeding in hypertensive patients with chronic kidney disease not on dialysis[J].Int J Clin Pract,2015,69(7): 722-728.
[1] 刘璐璐, 何羽. 慢性阻塞性肺病患者睡眠障碍的研究进展[J/OL]. 中华肺部疾病杂志(电子版), 2024, 17(05): 836-839.
[2] 马强. 衰弱和肌少症对肾功能评估的影响及干预策略[J/OL]. 中华肾病研究电子杂志, 2025, 14(01): 60-60.
[3] 余永武, 熊敏, 张凌. 慢性肾脏病矿物质和骨异常药物治疗研究新进展[J/OL]. 中华肾病研究电子杂志, 2025, 14(01): 44-47.
[4] 程柏凯, 杨光. 高胰岛素-正葡萄糖钳夹技术评估慢性肾脏病患者胰岛素抵抗的研究进展[J/OL]. 中华肾病研究电子杂志, 2024, 13(06): 334-339.
[5] 冯熔熔, 苏晓乐, 王利华. 慢性肾脏病患者并发心血管疾病相关生物标志物研究进展[J/OL]. 中华肾病研究电子杂志, 2024, 13(05): 273-278.
[6] 郭俊楠, 林惠, 任艺林, 乔晞. 氨基酸代谢异常在急性肾损伤向慢性肾脏病转变中的作用研究进展[J/OL]. 中华肾病研究电子杂志, 2024, 13(05): 283-287.
[7] 赵静, 张嘉欣, 高言, 谢席胜. 微小病变肾病的发病机制及治疗研究进展[J/OL]. 中华肾病研究电子杂志, 2024, 13(04): 207-212.
[8] 曹文钰, 郭鹏, 李锦平. 微创手术及非手术方式治疗慢性硬膜下血肿的研究进展[J/OL]. 中华神经创伤外科电子杂志, 2024, 10(05): 304-309.
[9] 吴广迎, 张延娟, 秦鹏, 卢艳丽. 经颈静脉肝内门体静脉分流术预防上消化道出血的临床研究[J/OL]. 中华消化病与影像杂志(电子版), 2024, 14(06): 545-548.
[10] 曹仔怡, 周加军. CKD-MBD与肌少症:深入探究其影响的研究新进展[J/OL]. 中华临床医师杂志(电子版), 2025, 19(01): 75-79.
[11] 刘琦, 王守凯, 王帅, 苏雨晴, 马壮, 陈海军, 司丕蕾. 乳腺癌肿瘤内微生物组的研究进展[J/OL]. 中华临床医师杂志(电子版), 2024, 18(09): 841-845.
[12] 奚培培, 周加军. 慢性肾脏病患者肌少症机制和诊治的研究进展[J/OL]. 中华临床医师杂志(电子版), 2024, 18(05): 491-495.
[13] 王星, 陈园, 热孜万古丽·乌斯曼, 郭艳英. T2DM、Obesity、NASH、PCOS共同致病因素相关的分子机制[J/OL]. 中华临床医师杂志(电子版), 2024, 18(05): 481-490.
[14] 王广宁, 李玉杰, 高坤范, 刘慧松. 短链脂肪酸在肌少症发病机制中的作用[J/OL]. 中华老年病研究电子杂志, 2024, 11(04): 31-37.
[15] 黄华, 梁志坚. 恶性肿瘤相关出血性卒中的研究进展[J/OL]. 中华脑血管病杂志(电子版), 2024, 18(06): 611-615.
阅读次数
全文


摘要