2型糖尿病患者幽门螺杆菌感染的流行病学调查及其与并发症的关系探讨
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摘要
本文先是调查2型糖尿病患者幽门螺杆菌感染与糖尿病患者上消化道症状的关系。以消化科门诊就诊的糖尿病患者和年龄、性别与其相匹配的非糖尿病非胃病患者为研究对象,进行平行对照研究。所有研究对象常规行胃镜检查和幽门螺杆菌检测,糖尿病患者还需做上消化道透视以明确是否存在胃轻瘫,调查了幽门螺杆菌感染与糖尿病患者年龄、病程、胃轻瘫、上消化道症状的关系,通过根除治疗调查糖尿病患者的根除率。本文的第二部分是对116例2型糖尿病患者临床资料进行回顾性分析,通过留取患者肘静脉血抗凝血浆以检测抗幽门螺杆菌抗体、纤维蛋白原、C反应蛋白,探讨幽门螺杆菌感染与糖尿病患者血脂、外周血炎症反应标志物及常见并发症的关系。以上研究结果表明糖尿病伴有胃轻瘫患者幽门螺杆菌感染率高于不伴胃轻瘫的糖尿病患者和非糖尿病患者;幽门螺杆菌感染率随糖尿病病程的延长呈逐渐增高趋势;糖尿病合并幽门螺杆菌感染者恶心、早饱、腹胀、上腹部疼痛的发病率高于糖尿病未合并幽门螺杆菌感染者,根除治疗有利于糖尿病患者上消化道症状的恢复;糖尿病患者根除率低于非糖尿病患者;糖尿病合并幽门螺杆菌感染者血清甘油三脂的水平显著高于糖尿病未合并幽门螺杆菌感染者,高密度脂蛋白胆固醇的水平低于糖尿病未合并幽门螺杆菌感染组;糖尿病合并幽门螺杆菌感染者和糖尿病未合并幽门螺杆菌感染者外周血炎症反应标志物的水平无明显差异。合并幽门螺杆菌感染的糖尿病患者冠心病和脑血管病发病率高于未合并幽门螺杆菌感染的糖尿病患者。
PART Ⅰ
Investigation of Helicobacter Pylori Infection in Type 2 Diabetic Patientsand Relations of Infection with Upper-Gastrointestinal Tract Symptoms .
Objective: To investigate the prevalence of helicobacter pylori(H.pylori)in type two diabetics, and the relations of infection with upper gastrointestinaltract symptoms and endoscopic feactures, observe efficacy of triple therapy.
Methods: A parallel-controlled study was conducted between 125 type 2diabetics and 125 nondiabetics without gastric disease in digest clinic. All thepatients had dyspeptic symptoms and gastroscopy ,serum antibody、rapid ureasetest and 14C-UBT examination were performed to diagnose H.pylori infection ,upper gastrointestinal symptoms and diabetic duration were noted in detail,upper gastrointestinal tract perspective after barium strip by mouth was neededto diagnose gastroparesis in diabetics. All patients affected by H.pylori receivedthe same triple therapy for 1 week, 4 weeks later after therapy, recheck14C-UBT to investigate the eradication rates of H.pylori. Results: Thedifference of H.pylori prevalence between diabetics and controls was notsignificant(p>0.05), but the diabetics with gastroparesis had a higher incidenceof H.pylori than those without gastroparesis and controls, the difference wassignificant (p<0.05);The infection rate of different age stages had notsignificant difference between diabetics and controls;The infection rate had anincreased tendency with diabetic duration;The incidence of early satiety、nausea、distention、superior belly pain were higher in diabetics affected byH.pylori than those were not affected (p<0.05);The incidence of early satiety
and distention was higher in diabetics with gastroparesis and H.pylori infectionthan other groups(p<0.01);The eradication rate of H.pylori in diabetics waslower than in controls, there was a significant difference between the twogroups(p<0.05).Conclusion: The infection of H.pylori may be associated withgastroparesis in diabetics. The infection rate had an increased tendency withdiabetic duration. Upper gastrointestinal tract symptoms in diabetics may beassociated with H.pylori infection, eradication of H.pylori may be helpful toimprove these symptoms, but the eradication rate of H.pylori is lower indiabetics than in nondiabetics.PART ⅡAssociation of Helicobacter Pylori Infection with Blood fat、Reactants ofInflammation in Peripheral Blood and Common Complications in Type 2DiabeticsObjective: To investigate the association of helicobacter pylori(H.pylori) infection with blood fat、reactants of inflammation in peripheralblood and common complications in type 2 diabetics. Methods: Chose 116type 2 diabetics in endocrine ward, Collecting vein anticoagulated blood plasmaand reserved in frozen in order to check H.pylori antibody、fibrinogen and CRPafterward. According clinical data conducted a retrospective study. Diabeticduration、smoking、drinking、inhabited environment、body weight、body height、blood pressure in quiescent condition 、 biochemical indicators andcomplications such as coronary heart disease、cerebrovasular disease were
recorded. Divided the diabetics into 2 groups by whether affected by H.pyloriand then performed a contrast study. Results: Alterations in the levels offollowing serum lipid were significantly more profound in H.pylori positivediabetics: High triglycerides(p<0.01)and low HDL cholesterol(p<0.05).Thelevels of reactants of inflammation such as WBC、PLT、Fg、CRP were nostatistically significant difference between the two groups;Coronary heartdisease and cerebrovascular disease were more prevalent in diabetics with thanwithout H.pylori infection(p<0.05),there was a significant difference,Othercomplications were no differently distributed. Conclusion: H.pylori infectionmay be one of causative factors of Coronary heart disease and cerebrovasculardisease in diabetics. The mechanism of H.pylori on Coronary heart disease andcerebrovascular disease in diabetics may be related with the affection ofH.pylori to lipid metabolism. The effect of H.pylori to reactants ofinflammation in peripheral blood is not obvious in diabetics.
PART Ⅰ
Investigation of Helicobacter Pylori Infection in Type 2 Diabetic Patientsand Relations of Infection with Upper-Gastrointestinal Tract Symptoms .
Objective: To investigate the prevalence of helicobacter pylori(H.pylori)in type two diabetics, and the relations of infection with upper gastrointestinaltract symptoms and endoscopic feactures, observe efficacy of triple therapy.
Methods: A parallel-controlled study was conducted between 125 type 2diabetics and 125 nondiabetics without gastric disease in digest clinic. All thepatients had dyspeptic symptoms and gastroscopy ,serum antibody、rapid ureasetest and 14C-UBT examination were performed to diagnose H.pylori infection ,upper gastrointestinal symptoms and diabetic duration were noted in detail,upper gastrointestinal tract perspective after barium strip by mouth was neededto diagnose gastroparesis in diabetics. All patients affected by H.pylori receivedthe same triple therapy for 1 week, 4 weeks later after therapy, recheck14C-UBT to investigate the eradication rates of H.pylori. Results: Thedifference of H.pylori prevalence between diabetics and controls was notsignificant(p>0.05), but the diabetics with gastroparesis had a higher incidenceof H.pylori than those without gastroparesis and controls, the difference wassignificant (p<0.05);The infection rate of different age stages had notsignificant difference between diabetics and controls;The infection rate had anincreased tendency with diabetic duration;The incidence of early satiety、nausea、distention、superior belly pain were higher in diabetics affected byH.pylori than those were not affected (p<0.05);The incidence of early satiety
and distention was higher in diabetics with gastroparesis and H.pylori infectionthan other groups(p<0.01);The eradication rate of H.pylori in diabetics waslower than in controls, there was a significant difference between the twogroups(p<0.05).Conclusion: The infection of H.pylori may be associated withgastroparesis in diabetics. The infection rate had an increased tendency withdiabetic duration. Upper gastrointestinal tract symptoms in diabetics may beassociated with H.pylori infection, eradication of H.pylori may be helpful toimprove these symptoms, but the eradication rate of H.pylori is lower indiabetics than in nondiabetics.PART ⅡAssociation of Helicobacter Pylori Infection with Blood fat、Reactants ofInflammation in Peripheral Blood and Common Complications in Type 2DiabeticsObjective: To investigate the association of helicobacter pylori(H.pylori) infection with blood fat、reactants of inflammation in peripheralblood and common complications in type 2 diabetics. Methods: Chose 116type 2 diabetics in endocrine ward, Collecting vein anticoagulated blood plasmaand reserved in frozen in order to check H.pylori antibody、fibrinogen and CRPafterward. According clinical data conducted a retrospective study. Diabeticduration、smoking、drinking、inhabited environment、body weight、body height、blood pressure in quiescent condition 、 biochemical indicators andcomplications such as coronary heart disease、cerebrovasular disease were
recorded. Divided the diabetics into 2 groups by whether affected by H.pyloriand then performed a contrast study. Results: Alterations in the levels offollowing serum lipid were significantly more profound in H.pylori positivediabetics: High triglycerides(p<0.01)and low HDL cholesterol(p<0.05).Thelevels of reactants of inflammation such as WBC、PLT、Fg、CRP were nostatistically significant difference between the two groups;Coronary heartdisease and cerebrovascular disease were more prevalent in diabetics with thanwithout H.pylori infection(p<0.05),there was a significant difference,Othercomplications were no differently distributed. Conclusion: H.pylori infectionmay be one of causative factors of Coronary heart disease and cerebrovasculardisease in diabetics. The mechanism of H.pylori on Coronary heart disease andcerebrovascular disease in diabetics may be related with the affection ofH.pylori to lipid metabolism. The effect of H.pylori to reactants ofinflammation in peripheral blood is not obvious in diabetics.
引文
1.Guvener N, Akcan Y, Paksoy I,et al. Helicobacter pylori associated gastric pathology in patients with type II diabetes mellitus and its relationship with gastric emptying: the Ankara study. Exp Clin Endocrinol Diabetes. 1999;107: 172-176.
2.Maule S, Lombardo L, Rossi C, et al. Helicobacter pylori infection and gastric function in primary autonomic neuropathy. Clin Auton Res.2002;12:193-196.
3.Gulcelik NE, Kaya E, Demirbas B, et al. Helicobacter pylori prevalence in diabetic patients and its relationship with dyspepsia and autonomic neuropathy. J Endocrinol Invest.2005;28: 214-217.
4.Marrollo M, Latella G, Melideo D, et al. Increased prevalence of Helicobacter pylori in patients with diabetes mellitus. Dig Liver Dis.2001;33:21-29.
5.Anastasios R, Goritsas C, Papamihail C,et al. Helicobacter pylori infection in diabetic patients: prevalence and endoscopic findings. Eur J Intern Med. 2002;13:376.
6.刘兰祥,张秉明,尹福在,沈轶,陆强.x 线新法诊断糖尿病胃轻瘫.中国医学影像学杂志.2000;8:377.
7.陆广华.糖尿病胃轻瘫的诊断与治疗.世界临床药物.2004;25:722-724.
8.中华医学会消化病学分会.幽门螺杆菌若干问题的共识意见.中华消化杂志.2000;20:117-118.
9. Wafula JM, Lule GN, Otieno CF, et al. Upper gastrointestinal findings in diabetic outpatients at Kenyatta National Hospital, Nairobi.2002;79:232-236.
10.Gasbarrini A, Ojetti V, Pitocco D, et al. Efficacy of different Helicobacter pylori eradication regimens in patients affected by insulin-dependent diabetes mellitus. Scand J Gastroenterol.2000;35:260-263.
11.Xia HH, Talley NJ, Kam EP, et al. Helicobacter pylori infection is not associated with diabetes mellitus, nor with upper gastrointestinal symptoms in diabetes mellitus. Am J Gastroenterol. 2001;96:1039-1046.
12.Guillermo I. Perez-Perez, Dietrich Rothenbacher, Hermann Brenner. Epidemiology of Helicobacter pylori Infection. Helicobacter. 2004;9(supp1): 1-6.
13.Sargyn M, Uygur-Bayramicli O, Sargyn H, et al. Type 2 diabetes mellitus affects eradication rate of Helicobacter pylori. World J Gastroenterol. 2003;9: 1126-1128.
14.Nilsson,Per-Henrik. Diabetic Gastroparesis: A Review. Journal of Diabetes and Its Complications.1996;10:113-122.
15.Kaneko H, Konagaya T, Kusugami K. Helicobacter pylori and gut hormones. J Gastroenterol.2002;37:77-86.
2.Maule S, Lombardo L, Rossi C, et al. Helicobacter pylori infection and gastric function in primary autonomic neuropathy. Clin Auton Res.2002;12:193-196.
3.Gulcelik NE, Kaya E, Demirbas B, et al. Helicobacter pylori prevalence in diabetic patients and its relationship with dyspepsia and autonomic neuropathy. J Endocrinol Invest.2005;28: 214-217.
4.Marrollo M, Latella G, Melideo D, et al. Increased prevalence of Helicobacter pylori in patients with diabetes mellitus. Dig Liver Dis.2001;33:21-29.
5.Anastasios R, Goritsas C, Papamihail C,et al. Helicobacter pylori infection in diabetic patients: prevalence and endoscopic findings. Eur J Intern Med. 2002;13:376.
6.刘兰祥,张秉明,尹福在,沈轶,陆强.x 线新法诊断糖尿病胃轻瘫.中国医学影像学杂志.2000;8:377.
7.陆广华.糖尿病胃轻瘫的诊断与治疗.世界临床药物.2004;25:722-724.
8.中华医学会消化病学分会.幽门螺杆菌若干问题的共识意见.中华消化杂志.2000;20:117-118.
9. Wafula JM, Lule GN, Otieno CF, et al. Upper gastrointestinal findings in diabetic outpatients at Kenyatta National Hospital, Nairobi.2002;79:232-236.
10.Gasbarrini A, Ojetti V, Pitocco D, et al. Efficacy of different Helicobacter pylori eradication regimens in patients affected by insulin-dependent diabetes mellitus. Scand J Gastroenterol.2000;35:260-263.
11.Xia HH, Talley NJ, Kam EP, et al. Helicobacter pylori infection is not associated with diabetes mellitus, nor with upper gastrointestinal symptoms in diabetes mellitus. Am J Gastroenterol. 2001;96:1039-1046.
12.Guillermo I. Perez-Perez, Dietrich Rothenbacher, Hermann Brenner. Epidemiology of Helicobacter pylori Infection. Helicobacter. 2004;9(supp1): 1-6.
13.Sargyn M, Uygur-Bayramicli O, Sargyn H, et al. Type 2 diabetes mellitus affects eradication rate of Helicobacter pylori. World J Gastroenterol. 2003;9: 1126-1128.
14.Nilsson,Per-Henrik. Diabetic Gastroparesis: A Review. Journal of Diabetes and Its Complications.1996;10:113-122.
15.Kaneko H, Konagaya T, Kusugami K. Helicobacter pylori and gut hormones. J Gastroenterol.2002;37:77-86.