苏州两所幼儿园儿童感染幽门螺杆菌的危险因素及口腔清洁措施对降低口腔幽门螺杆菌感染的作用
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摘要
目的了解学龄前儿童口腔幽门螺杆菌感染的危险因素,为幽门螺杆菌感染的预防提供积极有效的口腔清洁措施,降低幽门螺杆菌感染率。方法选择苏州市两所幼儿园的儿童204例,进行问卷调查,通过单因素配对资料卡方检验及多因素Logistic回归分析筛选出危险因素;采用幽门螺杆菌唾液检测试剂(HPS)方法和13C-尿素呼气试验(13C-UBT)检测口腔和胃幽门螺杆菌感染;选择抑制幽门螺杆菌的专用牙膏进行口腔清洁,2个月后用HPS方法复查口腔幽门螺杆菌感染。结果儿童的个人卫生如爱啃手指、爱啃玩具、饭前便后不常洗手;照养人的带养方式如咀嚼食物喂养、使用自己的筷子喂食、经常亲吻幼儿、饭前不常洗手;父母胃病史等为学龄前儿童幽门螺杆菌感染的危险因素。204例儿童中HPS阳性158例(占77.45%),13C-UBT阳性37例(占18.14%),HPS与13C-UBT均阳性28例(占13.73%),口腔幽门螺杆菌感染显著高于胃内幽门螺杆菌感染(P<0.01)。接受口腔清洁措施干预后,口腔幽门螺杆菌转阴率显著增高,表明干预有效(P<0.01)。结论教育儿童从小养成良好的卫生习惯,实行家庭分餐制或应用公筷,尽早发现幽门螺杆菌感染并定期选择专用牙膏进行口腔清洁,对预防幽门螺杆菌感染具有重要意义。
Objective This work aimed to identify the risk factors of Helicobacter pylori(H.pylori) infection in preschool children and provide effective measures for the prevention and reduction of the incidence of H.pylori infections.MethodsA total of 204 children from two kindergartens in Suzhou city were recruited through a questionnaire survey.Risk factors were selected through the single factor paired data χ2 test and multiple factor Logistic regression analysis.Oral and gastric H.pylori infections were detected by using H.pylori saliva detection(HPS) and 13 C-urea breath test(13 C-UBT).Special toothpaste for H.pylori control was selected for oral cleaning.Oral H.pylori infection rates at 2 months after special toothpaste treatment were examined by using HPS.Results The high-risk factors of H.pylori infections among preschool children included poor personal hygiene habits,such as the nibbling of fingers and the avoidance of hand-washing before meals,diet,and parent's history of stomach disease.Among the 204 subjects enrolled in this study,158(77.45%),37(18.14%),and 28(13.73%) were HPS positive,13 C-UBT positive,and HPS and 13 C-UBT positive,respectively.The incidence of oral H.pylori infections was significantly higher than that of gastric H.pylori infections(P<0.01).The positive rate of infections significantly decreased after special toothpaste treatment(P<0.01).This result indicates that the intervention was effective.Conclusion Children must receive education on good eating habits.Individualized dining habits or the use of public chopsticks must be implemented.H.pylori infections must be detected as early as possible.Specific toothpaste for oral cleaning must be selected.These approaches could drastically prevent or reduce the incidence of H.pylori infections among preschool children.
Objective This work aimed to identify the risk factors of Helicobacter pylori(H.pylori) infection in preschool children and provide effective measures for the prevention and reduction of the incidence of H.pylori infections.MethodsA total of 204 children from two kindergartens in Suzhou city were recruited through a questionnaire survey.Risk factors were selected through the single factor paired data χ2 test and multiple factor Logistic regression analysis.Oral and gastric H.pylori infections were detected by using H.pylori saliva detection(HPS) and 13 C-urea breath test(13 C-UBT).Special toothpaste for H.pylori control was selected for oral cleaning.Oral H.pylori infection rates at 2 months after special toothpaste treatment were examined by using HPS.Results The high-risk factors of H.pylori infections among preschool children included poor personal hygiene habits,such as the nibbling of fingers and the avoidance of hand-washing before meals,diet,and parent's history of stomach disease.Among the 204 subjects enrolled in this study,158(77.45%),37(18.14%),and 28(13.73%) were HPS positive,13 C-UBT positive,and HPS and 13 C-UBT positive,respectively.The incidence of oral H.pylori infections was significantly higher than that of gastric H.pylori infections(P<0.01).The positive rate of infections significantly decreased after special toothpaste treatment(P<0.01).This result indicates that the intervention was effective.Conclusion Children must receive education on good eating habits.Individualized dining habits or the use of public chopsticks must be implemented.H.pylori infections must be detected as early as possible.Specific toothpaste for oral cleaning must be selected.These approaches could drastically prevent or reduce the incidence of H.pylori infections among preschool children.
引文
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[7]孙佳,法永红,杨永进,等.幽门螺杆菌与口腔疾病的相关性研究进展[J].国际口腔医学杂志,2015,42(1):93-96.Sun J,Fa YH,Yang YJ,et al.Research progress on the correlation between Helicobacter pylori and associated oral disease[J].Int J Stomatol,2015,42(1):93-96.
[8]Cherati MR,Shokri-Shirvani J,Karkhah A,et al.Helicobacter pylori cagL amino acid polymorphism D58E59 pave the way toward peptic ulcer disease while N58E59 is associated with gastric cancer in north of Iran[J].Microb Pathog,2017,107:413-418.
[9]郭瑞,居军,杨森.口腔内幽门螺杆菌的探讨[J].国际检验医学杂志,2014,35(24):3390-3392.Guo R,Ju J,Yang S.Discussion of Helicobacter pylori in oral cavity[J].Int J Lab Med,2014,35(24):3390-3392.
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[11]Namiot D,Leszczyńska K,Namiot Z,et al.The occurrence of Helicobacter pylori antigens in dental plaque;an association with oral health status and oral hygiene practices[J].Adv Med Sci,2010,55(2):167-171.
[12]李小兵,包云光,赖盼建,等.幽门螺杆菌感染对儿童生长发育及营养状况的影响[J].中华临床感染病杂志,2015,8(3):258-262.Li XB,Bao YG,Lai PJ,et al.Growth and nutritional status of children with Helicobacter pylori infections[J].Chin JClin Infect Dis,2015,8(3):258-262.
[13]宋文仕.儿童消化性溃疡38例诊治探讨[J].中华全科医学,2010,8(9):1151-1152.Song WS.Diagnosis and treatment of 38 cases of children peptic ulcer[J].Chin J Gener Pract,2010,8(9):1151-1152.
[14]叶国钦.儿童幽门螺杆菌感染的新思考[J].中国当代儿科杂志,2014,16(3):248-254.Yee KC.Helicobacter pylori infection in children:a new focus[J].Chin J Contemp Pedia,2014,16(3):248-254.
[15]王晓敏,赵燕,陈楠,等.唾液测试板检测口腔幽门螺杆菌的实用性研究[J].华西口腔医学杂志,2012,30(5):501-504.Wang XM,Zhao Y,Chen N,et al.Study of the pragmatic of saliva test cassette to detect the Helicobacter pylori in oral cavity[J].West Chin J Stomatol,2012,30(5):501-504.
[16]杨雁华,刘玉萍,程幼夫,等.应用13C-尿素呼气试验检测成都市健康体检者胃幽门螺杆菌感染情况分析[J].实用医院临床杂志,2013,10(2):71-73.Yang YH,Liu YP,Cheng YF,et al.Application of 13C-urea breath test in screening Helicobacter pylori infection during health examination in Chengdu,Sichuan[J].Pract J Clin Med,2013,10(2):71-73.
[17]刘文忠,谢勇,陆红,等.第五次全国幽门螺杆菌感染处理共识报告[J].中国实用内科杂志,2017,37(6):509-524.Liu WZ,Xie Y,Lu H,et al.The fifth Chinese national consensus report on the management of Helicobacter pylori infection[J].Chin J Pract Int Med,2017,37(6):509-524.
[18]Wizla-Derambure N,Michaud L,Ategbo S,et al.Familial and community environmental risk factors for Helicobacter pylori infection in children and adolescents[J].J Pediatr Gastroenterol Nutr,2001,33(1):58-63.
[19]Travis PB,Goodman KJ,O’Rourke KM,et al.The association of drinking water quality and sewage disposal with Helicobacter pylori incidence in infants:the potential role of water-borne transmission[J].J Water Health,2010,8(1):192-203.
[20]Ding Z,Zhao S,Gong S,et al.Prevalence and risk factors of Helicobacter pylori infection in asymptomatic Chinese children:a prospective,cross-sectional,population-based study[J].Aliment Pharm Therap,2015,42(8):1019-1026.
[21]Rahman R,Asombang AW,Ibdah JA.Characteristics of gastric cancer in Asia[J].World J Gastroenterol,2014,20(16):4483-4490.
[22]Calvet X,Lehours P,Lario S,et al.Diagnosis of Helicobacter pylori infection[J].Helicobacter,2010(Suppl 1):7-13.
[23]Yucel O.Prevention of Helicobacter pylori infection in childhood[J].World J Gastroenterol,2014,20(30):10348-10354.
[24]蔡海芳.儿童口腔幽门螺杆菌感染与胃内幽门螺杆菌感染相关研究进展[J].国际儿科学杂志,2013,40(3):264-267.Cai HF.Correlation between Helicobacter pylori infection in oral cavity and Helicobacter pylori infection in stomach in children[J].Int J Pedia,2013,40(3):264-267.
[25]Momtaz H,Souod N,Dabiri H,et al.Study of Helicobacter pylori genotype status in saliva,dental plaques,stool and gastric biopsy samples[J].World J Gastroenterol,2012,18(17):2105-2111.
[26]Iwańczak B,Francavailla R.Helicobacter pylori infection in pediatrics[J].Helicobacter,2014,19(1):46-51.
[27]刘彦琦,赵爱珍,苏秉忠,等.学龄儿童幽门螺杆菌感染状况调查及其危险因素分析[J].中国儿童保健杂志,2014,22(4):432-434.Liu YQ,Zhao AZ,Su BZ,et al.Analysis of Helicobacter pylori infection and its risk factors in school-age children[J].Chin J Child Health Care,2014,22(4):432-434.
[28]叶国钦.探索清除口腔幽门螺杆菌的几条思路[J].中华医学杂志,2012,92(40):2811-2813.Yee KC.To explore several ways of eliminating Helicobacter pylori in oral cavity[J].Nation Med J Chin,2012,92(40):2811-2813.
[2]Krajden S,Fuksa M,Anderson J,et al.Examination of human stomach biopsies,saliva,and dental plaque for Campylobacter pylori[J].J Clin Microbiol,1989,27(6):1397-1398.
[3]Ferguson DA Jr,Li C,Patel NR,et al.Isolation of Helicobacter pylori from saliva[J].J Clin Microbiol,1993,31(10):2802-2804.
[4]胡文杰,曹采方,孟焕新,等.幽门螺杆菌在口腔中的特征性分布[J].中国微生态学杂志,2004,16(2):93-95.Hu WJ,Cao CF,Meng HX,et al.Characteristic distribution of Helicobacter pylori in the oral cavity[J].Chin J Microecol,2004,16(2):93-95.
[5]Zou QH,Li RQ.Helicobacter pylori in the oral cavity and gastric mucosa:a meta-analysis[J].J Oral Pathol Med,2011,40(4):317-324.
[6]杨锴毓,李雨庆,周学东.口腔幽门螺杆菌与胃幽门螺杆菌感染关系的研究进展[J].华西口腔医学杂志,2014,32(3):314-318.Yang KY,Li YQ,Zhou XD.Overview of researches for Helicobacter pylori in oral cavity and stomach[J].West Chin J Stomatol,2014,32(3):314-318.
[7]孙佳,法永红,杨永进,等.幽门螺杆菌与口腔疾病的相关性研究进展[J].国际口腔医学杂志,2015,42(1):93-96.Sun J,Fa YH,Yang YJ,et al.Research progress on the correlation between Helicobacter pylori and associated oral disease[J].Int J Stomatol,2015,42(1):93-96.
[8]Cherati MR,Shokri-Shirvani J,Karkhah A,et al.Helicobacter pylori cagL amino acid polymorphism D58E59 pave the way toward peptic ulcer disease while N58E59 is associated with gastric cancer in north of Iran[J].Microb Pathog,2017,107:413-418.
[9]郭瑞,居军,杨森.口腔内幽门螺杆菌的探讨[J].国际检验医学杂志,2014,35(24):3390-3392.Guo R,Ju J,Yang S.Discussion of Helicobacter pylori in oral cavity[J].Int J Lab Med,2014,35(24):3390-3392.
[10]Esfahanizadeh N,Modanlou R.Correlation between oral hygiene and Helicobacter pylori infection[J].Acta Med Iran,2010,48(1):42-46.
[11]Namiot D,Leszczyńska K,Namiot Z,et al.The occurrence of Helicobacter pylori antigens in dental plaque;an association with oral health status and oral hygiene practices[J].Adv Med Sci,2010,55(2):167-171.
[12]李小兵,包云光,赖盼建,等.幽门螺杆菌感染对儿童生长发育及营养状况的影响[J].中华临床感染病杂志,2015,8(3):258-262.Li XB,Bao YG,Lai PJ,et al.Growth and nutritional status of children with Helicobacter pylori infections[J].Chin JClin Infect Dis,2015,8(3):258-262.
[13]宋文仕.儿童消化性溃疡38例诊治探讨[J].中华全科医学,2010,8(9):1151-1152.Song WS.Diagnosis and treatment of 38 cases of children peptic ulcer[J].Chin J Gener Pract,2010,8(9):1151-1152.
[14]叶国钦.儿童幽门螺杆菌感染的新思考[J].中国当代儿科杂志,2014,16(3):248-254.Yee KC.Helicobacter pylori infection in children:a new focus[J].Chin J Contemp Pedia,2014,16(3):248-254.
[15]王晓敏,赵燕,陈楠,等.唾液测试板检测口腔幽门螺杆菌的实用性研究[J].华西口腔医学杂志,2012,30(5):501-504.Wang XM,Zhao Y,Chen N,et al.Study of the pragmatic of saliva test cassette to detect the Helicobacter pylori in oral cavity[J].West Chin J Stomatol,2012,30(5):501-504.
[16]杨雁华,刘玉萍,程幼夫,等.应用13C-尿素呼气试验检测成都市健康体检者胃幽门螺杆菌感染情况分析[J].实用医院临床杂志,2013,10(2):71-73.Yang YH,Liu YP,Cheng YF,et al.Application of 13C-urea breath test in screening Helicobacter pylori infection during health examination in Chengdu,Sichuan[J].Pract J Clin Med,2013,10(2):71-73.
[17]刘文忠,谢勇,陆红,等.第五次全国幽门螺杆菌感染处理共识报告[J].中国实用内科杂志,2017,37(6):509-524.Liu WZ,Xie Y,Lu H,et al.The fifth Chinese national consensus report on the management of Helicobacter pylori infection[J].Chin J Pract Int Med,2017,37(6):509-524.
[18]Wizla-Derambure N,Michaud L,Ategbo S,et al.Familial and community environmental risk factors for Helicobacter pylori infection in children and adolescents[J].J Pediatr Gastroenterol Nutr,2001,33(1):58-63.
[19]Travis PB,Goodman KJ,O’Rourke KM,et al.The association of drinking water quality and sewage disposal with Helicobacter pylori incidence in infants:the potential role of water-borne transmission[J].J Water Health,2010,8(1):192-203.
[20]Ding Z,Zhao S,Gong S,et al.Prevalence and risk factors of Helicobacter pylori infection in asymptomatic Chinese children:a prospective,cross-sectional,population-based study[J].Aliment Pharm Therap,2015,42(8):1019-1026.
[21]Rahman R,Asombang AW,Ibdah JA.Characteristics of gastric cancer in Asia[J].World J Gastroenterol,2014,20(16):4483-4490.
[22]Calvet X,Lehours P,Lario S,et al.Diagnosis of Helicobacter pylori infection[J].Helicobacter,2010(Suppl 1):7-13.
[23]Yucel O.Prevention of Helicobacter pylori infection in childhood[J].World J Gastroenterol,2014,20(30):10348-10354.
[24]蔡海芳.儿童口腔幽门螺杆菌感染与胃内幽门螺杆菌感染相关研究进展[J].国际儿科学杂志,2013,40(3):264-267.Cai HF.Correlation between Helicobacter pylori infection in oral cavity and Helicobacter pylori infection in stomach in children[J].Int J Pedia,2013,40(3):264-267.
[25]Momtaz H,Souod N,Dabiri H,et al.Study of Helicobacter pylori genotype status in saliva,dental plaques,stool and gastric biopsy samples[J].World J Gastroenterol,2012,18(17):2105-2111.
[26]Iwańczak B,Francavailla R.Helicobacter pylori infection in pediatrics[J].Helicobacter,2014,19(1):46-51.
[27]刘彦琦,赵爱珍,苏秉忠,等.学龄儿童幽门螺杆菌感染状况调查及其危险因素分析[J].中国儿童保健杂志,2014,22(4):432-434.Liu YQ,Zhao AZ,Su BZ,et al.Analysis of Helicobacter pylori infection and its risk factors in school-age children[J].Chin J Child Health Care,2014,22(4):432-434.
[28]叶国钦.探索清除口腔幽门螺杆菌的几条思路[J].中华医学杂志,2012,92(40):2811-2813.Yee KC.To explore several ways of eliminating Helicobacter pylori in oral cavity[J].Nation Med J Chin,2012,92(40):2811-2813.
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