脓毒症或脓毒性休克患者应激性溃疡和胃肠道出血的相关因素：一项系统评价。
完整摘要 · 中文译文
背景：脓毒症仍然是危重患者死亡的主要原因之一，并给医疗资源带来沉重负担。除引起全身性炎症和影响血流动力学外，脓毒症还对胃肠道系统产生显著影响，导致应激性溃疡和明显的消化道出血（GIB）等并发症，从而恶化患者预后。虽然应激性溃疡预防（SUP）传统上被纳入脓毒症治疗方案，但由于缺乏明确的死亡率获益以及存在不良事件（如医院获得性肺炎）的风险，普遍应用该措施的理念正日益受到审视。然而，专门探讨脓毒症患者应激性溃疡独立危险因素的综合性研究仍存在明显空白。 方法：我们按照PRISMA标准开展了一项系统评价，检索了八个数据库（CNKI、万方、维普、Sinomed、PubMed、Web of Science、Embase和Cochrane Library），检索时间自各数据库建库至2026年9月1日。我们纳入了观察性分析研究（队列研究或病例对照研究），这些研究探讨了与成人脓毒症患者应激性溃疡或明显消化道出血相关的因素。两名研究者独立完成研究筛选、数据提取，并使用纽卡斯尔-渥太华量表进行质量评价。由于各相关因素与结局之间关联的研究数量有限，故采用叙述性综合方法。 结果：共纳入六项研究 共分析了131568例脓毒症或脓毒性休克患者。应激性溃疡或胃肠道出血（GIB）的发生率在2.0%至32.3%之间。已识别的相关因素分为三类：患者相关因素（高龄、GIB病史、肝硬化、HIV、癌症/免疫抑制）、疾病相关因素（凝血功能障碍、肾功能损害、高BUN水平、疾病严重程度评分、感染来源）和治疗相关因素（机械通气、使用抗凝药物、皮质类固醇治疗、ICU住院时间）。具体对于应激性溃疡，呼吸衰竭、高BUN水平、休克以及HMGB1/TLR2/TLR4水平升高被发现在独立地与更高的比值相关。 结论：总之，脓毒症患者发生应激性溃疡和胃肠道出血的可能性受多种与患者、其疾病及所接受治疗相关的因素影响。持续出现的关键指标包括凝血问题、休克的存在、机械通气的需求、肝肾功能障碍、疾病严重程度以及既往任何胃肠道出血事件。这些结果支持基于个体风险制定应激性溃疡预防的定制策略，而非一刀切的方法，为精准临床决策提供了重要见解。需要更多高质量研究来确认和加深对这些相关因素的理解。 注册：PROSPERO（CR D420251242849）。
完整摘要 · 英文原文
BACKGROUND: Sepsis continues to be a major contributor to death among critically ill individuals and places a heavy strain on healthcare resources. In addition to causing systemic inflammation and affecting hemodynamics, sepsis has a significant effect on the gastrointestinal system, leading to complications like stress ulcers and notable gastrointestinal bleeding (GIB), which worsen patient outcomes. While stress ulcer prophylaxis (SUP) has traditionally been included in sepsis treatment protocols, the concept of applying it universally is being increasingly scrutinized due to the absence of definitive mortality advantages and the risk of adverse effects, such as hospital-acquired pneumonia. Nevertheless, there is a notable gap in synthesized research that specifically addresses the independent risk factors for stress ulcers in sepsis patients. METHODS: We carried out a systematic review in accordance with PRISMA standards, exploring eight databases (CNKI, Wanfang, VIP, Sinomed, PubMed, Web of Science, Embase, and Cochrane Library) from their inception until September 1, 2026. We included observational analytical studies (either cohort or case-control) that examined factors linked to stress ulcers or significant gastrointestinal bleeding in adult patients with sepsis. Two researchers independently handled the selection of studies, extraction of data, and evaluation of quality using the Newcastle-Ottawa Scale. Due to the limited number of studies for each association between associated factors and outcomes, a narrative synthesis was utilized. RESULTS: A total of six studies encompassing 131,568 individuals suffering from sepsis or septic shock were analyzed. The incidence rates of stress ulcers or gastrointestinal bleeding (GIB) varied between 2.0% and 32.3%. The identified associated factors were divided into three categories: patient-related (older age, history of GIB, cirrhosis, HIV, cancer/immunosuppression), disease-related (coagulopathy, kidney impairment, high BUN levels, severity of illness scores, source of infection), and treatment-related (mechanical ventilation, use of anticoagulants, corticosteroid therapy, duration of ICU stay). Specifically for stress ulcer, factors such as respiratory failure, high BUN levels, shock, and increased HMGB1/TLR2/TLR4 levels were found to be independently linked to a higher odds. CONCLUSIONS: In summary, the likelihood of developing stress ulcers and gastrointestinal bleeding in patients with sepsis is shaped by a variety of factors related to the patient, their illness, and the treatments they receive. Key indicators that consistently emerge include issues with blood coagulation, the presence of shock, the need for mechanical ventilation, liver and kidney dysfunction, the severity of the disease, and any previous occurrences of gastrointestinal bleeding. These results advocate for tailored strategies for stress ulcer prophylaxis based on individual risk rather than a one-size-fits-all approach, offering crucial insights for precise clinical decision-making. Additional high-quality research is essential to confirm and enhance the understanding of these associated factors. REGISTRATION: PROSPERO (CRD420251242849).