2型糖尿病患者幽门螺杆菌再感染因素分析
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摘要
目的研究2型糖尿病(T2DM)患者四联抗幽门螺杆菌(HP)根除治疗48周后再感染影响因素。方法纳入我院内分泌科住院的T2DM患者179例,经~(13)C尿素呼气试验检测HP阳性者108例,予以患者四联抗HP治疗2周,停药后4周复查HP阴性者97例继续随访,48周时再次复查HP;根据48周复测结果分为HP再感染阳性(HP阳性)组与HP再感染阴性(HP阴性)组。比较2组年龄、性别、体质量指数(BMI)、糖化血红蛋白(HbA1c)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、血尿酸(UA)、糖尿病(DM)病程、是否使用胰岛素、月收入≥3 000元、吸烟史及饮酒史等指标的差异;探讨各个变量对HP再感染的影响。结果 T2DM患者中HP感染率为60.3%(108/179);4周时HP根除率为89.8%(97/108),48周时HP再感染率为23.7%(23/97);HP阳性组的DM病程、HbA1c均高于HP阴性组,HP阴性组的月收入≥3 000元患者比例高于HP阳性组(P<0.05);余指标2组差异无统计学意义(P>0.05)。二分类Logistic回归分析结果显示,DM病程较长(OR=1.195,95%CI:1.049～1.136)、HbA1c升高(OR=1.293,95%CI 1.011～1.518)是HP再感染的危险因素。结论在T2DM人群中存在HP再感染,DM病程越长及HbA1c越高者HP再感染可能性越大。
Objective To analyze the influencing factors of helicobacter pylori(HP) reinfection in patients with type 2 diabetes mellitus(T2DM) 48 weeks after a successful standard eradicating treatment.Methods A total of 179 T2DM patients from endocrine department of our hospital were included in our study. Among them 108 patients were evaluated HP infection by means of ~(13)C-Urea Breath Test. All positive patients were eradicated by means of a standard quadruple therapy for 2 weeks. The eradication of HP was confirmed by means of ~(13)C-Urea Breath Test performed at least four weeks after therapy, and 97 patients were successfully eradicated. After 48 weeks of follow-up, 97 patients underwent another ~(13)C-Urea Breath Test. It was found that 74 out of 97 patients were negative and 23 positive for HP reinfection. The clinical data of 97 patients were collected and compared between two groups(HP negative group and HP positive group), including age, sex,body mass index(BMI), hemoglobin A1 c(HbA1c), triglyceride(TG), low density lipoprotein cholesterol(LDL-C), total cholesterol(TC), high density lipoprotein cholesterol(HDL-C), Uric acid(UA), the duration of diabetes mellitus(DM),insulin usage, socio-economic status(monthly income ≥ 3 000 yuan) and the history of smoking and drinking. The effects of these variables on HP reinfection were also evaluated.Results The prevalence of HP was 60.3%(108/179). The eradication rate of HP was 89.8%(97/108). The reinfection rate was 23.7%(23/97) after 48-week of follow-up. The duration of DM and the level of HbA1c were significantly higher, and the proportion of patients with monthly income ≥3 000 yuan was significantly lower in HP positive group than those of HP negative group(P<0.05). There were no significant differences in other indexes between two groups(P>0.05). Binary logistic regression analysis showed that the duration of DM(OR=1.195,95%CI 1.049-1.136) and the level of HbA1c(OR=1.293, 95%CI 1.011～1.518) were risk factors of HP reinfection.Conclusion According to our data, there is HP reinfection in T2DM patients. The long duration of DM and high level of HbA1c are associated with HP reinfection.
Objective To analyze the influencing factors of helicobacter pylori(HP) reinfection in patients with type 2 diabetes mellitus(T2DM) 48 weeks after a successful standard eradicating treatment.Methods A total of 179 T2DM patients from endocrine department of our hospital were included in our study. Among them 108 patients were evaluated HP infection by means of ~(13)C-Urea Breath Test. All positive patients were eradicated by means of a standard quadruple therapy for 2 weeks. The eradication of HP was confirmed by means of ~(13)C-Urea Breath Test performed at least four weeks after therapy, and 97 patients were successfully eradicated. After 48 weeks of follow-up, 97 patients underwent another ~(13)C-Urea Breath Test. It was found that 74 out of 97 patients were negative and 23 positive for HP reinfection. The clinical data of 97 patients were collected and compared between two groups(HP negative group and HP positive group), including age, sex,body mass index(BMI), hemoglobin A1 c(HbA1c), triglyceride(TG), low density lipoprotein cholesterol(LDL-C), total cholesterol(TC), high density lipoprotein cholesterol(HDL-C), Uric acid(UA), the duration of diabetes mellitus(DM),insulin usage, socio-economic status(monthly income ≥ 3 000 yuan) and the history of smoking and drinking. The effects of these variables on HP reinfection were also evaluated.Results The prevalence of HP was 60.3%(108/179). The eradication rate of HP was 89.8%(97/108). The reinfection rate was 23.7%(23/97) after 48-week of follow-up. The duration of DM and the level of HbA1c were significantly higher, and the proportion of patients with monthly income ≥3 000 yuan was significantly lower in HP positive group than those of HP negative group(P<0.05). There were no significant differences in other indexes between two groups(P>0.05). Binary logistic regression analysis showed that the duration of DM(OR=1.195,95%CI 1.049-1.136) and the level of HbA1c(OR=1.293, 95%CI 1.011～1.518) were risk factors of HP reinfection.Conclusion According to our data, there is HP reinfection in T2DM patients. The long duration of DM and high level of HbA1c are associated with HP reinfection.
引文
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[11]范国洽,周亚茹.2型糖尿病与幽门螺杆菌感染[J].中华糖尿病杂志,2013,5(11):702-704.Fan GQ,Zhou YR.Type 2 diabetes mellitus and helicobacter pylori infection[J].Chin J Diabetes Mellitus,2013,5(11):702-704.doi:10.3760/cma.j.issn.1674-5809.2013.11.013.
[2]朱春英,张英福,李志红,等.幽门螺杆菌感染与糖尿病的相关性[J].河北医药,2017,39(3):445-447.Zhu CY,Zhang YF,Li ZH,et al.The correlation between helicobacter pylori infection and diabetes mellitus[J].Hebei Medical Journal,2017,39(3):445-447.doi:10.3969/j.issn.1002-7386.2017.03.037.
[3]卢瑜,方勇,王青青,等.糖尿病与恶性肿瘤关系的回顾性临床研究[J].中华内分泌代谢杂志,2010,26(3):183-187.Lu Y,Fang Y,Wang QQ,et al.A retrospective analysis of the correlation between diabetes mellitus and cancer[J].Chin J Endocrinal Metab,2010,26(3):183-187.doi:10.3760/cma.j.issn.1000-6699.2010.03.003.
[4]中华医学会消化病学分会幽门螺杆菌和消化性溃疡学组,全国幽门螺杆菌研究协作组,刘文忠,等.第五次全国幽门螺杆菌感染处理共识报告[J].中华消化杂志,2017,37(6):364-378.Chinese Society of Gastroenterology,Chinese Study Group on Helicobacter pylori and Peptic Ulcer,Liu WZ,et al.The fifth chinese national consensus report on management of helicobacter pylori infection[J].Chin J Dig,2017,37(6):364-378.doi:10.3760/cma.j.issn.0254-1432.2017.06.002.
[5]Herrero R,Park JY,Forman D.The fight against gastric cancerthe IARC Working Group report[J].Best Pract Res Clin Gastroenterol,2014,28(6):1107-1114.doi:10.1016/j.bpg.2014.10.003.
[6]Wang F,Liu J,Lv Z.Association of Helicobacter pylori infection with diabetes mellitus and diabetic nephropathy:a meta-analysis of39 studies involving more than 20,000 participants[J].Scand JInfect Dis,2013,45(12):930-938.doi:10.3109/00365548.2013.844351.
[7]谭淑红,郝庆,李岩.成人幽门螺杆菌根除后复发的研究进展[J].中国实用内科杂志,2017,37(9):852-856.Tan SH,Hao Q,Li Y.Research progress on recurrence of Helicobacter pylori infection after eradication in adults[J].Chinese Journal of Practical Internal Medicine,2017,37(9):852-856.doi:10.19538/j.nk2017090116.
[8]孙萍,盛家和,许青霞,等.不同型别幽门螺杆菌感染的高血压患者血清中TNF-α、IL-6、IL-8水平研究[J].传染病信息,2018,31(2):165-167.Sun P,Sheng JH,Xu QX,et al.Serum levels of TNF-α,IL-6 and IL-8 in hypertensive patients with different types of Helicobacter pylori infection[J].Infect Dis Info,2018,31(2):165-167.doi:10.3969/j.issn.1007-8134.2018.02.017.
[9]Valenzuela MA,Canales J,Corvalán AH,et al.Helicobacter pyloriinduced inflammation and epigenetic changes during gastric carcinogenesis[J].World J Gastroenterol,2015,21(45):12742-12756.doi:10.3748/wjg.v21.i45.12742.
[10]Horikawa C,Kodama S,Fujihara K,et al.Association of helicobacter pylori infection with glycemic control in patients with diabetes:a meta-analysis[J].J Diabetes Res,2014,2014:250620.doi:10.1155/2014/250620.
[11]范国洽,周亚茹.2型糖尿病与幽门螺杆菌感染[J].中华糖尿病杂志,2013,5(11):702-704.Fan GQ,Zhou YR.Type 2 diabetes mellitus and helicobacter pylori infection[J].Chin J Diabetes Mellitus,2013,5(11):702-704.doi:10.3760/cma.j.issn.1674-5809.2013.11.013.