AIDS与肝病患者胃镜活检组织幽门螺杆菌感染和消化性溃疡发现率的临床比较研究

Relationship of AIDS with Helicobacter pylori in gastric mucous epithelium of hepatic disease and peptic ulcer of gastroscopy patients

目的探讨艾滋病、肝病和普通人群上中腹不适的患者胃幽门螺旋杆菌(H.pylori)感染发生率的异同,以发现H.pylori感染在诱发艾滋病患者和肝病患者消化性溃疡过程中作用的异同。方法艾滋病组患者46例,肝病组患者668例,非艾滋病非肝病普通人群对照组226例,均有上腹不适,行胃镜检查,活检组织分别进行快速尿素酶和Warthin-Starry银染检测H.pylori感染,同时记录内镜下发现的病变。结果肝病患者H.pylori感染率(36.08%)低于艾滋病患者(43.48%)和普通人群对照组(59.73%)(P<0.05),艾滋病患者H.pylori感染低于普通人群对照组患者(P<0.05);肝病伴发消化性溃疡患者的H.pylori感染率(45.22%)低于普通人群消化性溃疡患者的H.pylori感染率(80.49%)(P<0.05),艾滋病伴发消化性溃疡的H.pylori感染率(50.00%)与普通人群无差异(P>0.05)。结论 H.pylori肝病患者消化性溃疡的发生与H.pylori感染的关系,不像普通人群消化性溃疡的发生与H.pylori感染的关系密切;而艾滋病患者中H.pylori感染率即使低于普通人群,H.pylori感染仍是促进艾滋病患者发生消化性溃疡的重要因素。

Objective To understand the difference of helicobacter pylori infection rates among the patients with AIDS,patients with hepatic diseases,and the persons with epigastrium discomfort but without AIDS and hepatic disease,study the role of helicobacter pylori in the pathogenesis of peptic ulcer found in patients with AIDS and patients with hepatic disease.Methods Forty-six patients with AIDS,668 patients with hepatic disease and 226 persons without AIDS and hepatic disease from outpatient service in Shanghai Public Health Clinic Center were all with epigastrium discomfort and gastroscopy was performed on them.Their gastric mucous epithelia from biopsy were used to detect helicobacter pylori with rapid urase test and Warthin-Starry silver staining.Results The helicobacter pylori infection rate in the patients with hepatic disease（36.08%） was statistically lower than that in the patients with AIDS（43.48%） and the persons with epigastrium discomfort but without AIDS and hepatic disease（59.73%）（P〈0.05）.The helicobacter pylori infection rate of the patients with hepatic diseases accompanied with peptic ulcer（45.22%） was statistically lower than that in the persons with epigastrium discomfort but without AIDS and hepatic disease accompanied peptic ulcer（80.49%）.However,there was no statistical difference between the patients with AIDS accompanied with peptic ulcer（50.00%） and the persons with epigastrium discomfort but without AIDS and hepatic disease accompanied peptic ulcer.Conclusion The helicobacter pylorus is not a key factor in pathogenesis of peptic ulcer of the patient with hepatic disease.However,50% of the patients with AIDS accompanied peptic ulcer are infected by helicobacter pylori,so helicobacter pylori could be a contributing factor to pathogenesis of peptics ulcer in the patients with AIDS.