乙肝相关性肝病患者幽门螺杆菌感染的研究

Prevalence of Hp infection in hepatitis B virus-relative liver disease patients

目的研究慢性乙型肝炎(乙肝)、乙肝肝硬化、乙肝后肝癌等肝病患者幽门螺杆菌(Hp)感染情况。方法收集慢性乙肝、乙肝肝硬化、乙肝后肝癌等肝脏疾病患者273例,日期正常体检人群60例,采用免疫层析法检测患者血清中抗Hp抗体(Hp-IgG),定量PCR检测HBV DNA。结果乙肝相关性肝病患者Hp感染率73.3%,正常体检人群为40.0%,2组比较差异有统计学意义(P<0.01);慢性乙肝、乙肝肝硬化、乙肝后肝癌3组患者Hp感染率分别为62.7%、77.0%、79.7%,后二者Hp明显高于慢性乙肝患者(P<0.05);按病毒载量分级,HBV DNA阴性组Hp感染率低于HBV DNA阳性组,而阳性组按低、中、高分组,各组间Hp感染率分别为69.4%、65.0%、66.1%(P>0.05);乙肝肝硬化患者按Child-push分级后,A、B、C各级之间的Hp感染率分别为51.9%、63.4%、65.6%(P>0.05)。结论 Hp感染可能参与乙肝肝病患者肝脏损伤,显示Hp具有肝细胞毒性作用;肝硬化、肝癌感染率高于慢性乙型肝炎,提示Hp感染与慢性肝病疾病进展和肝癌的发生有一定相关性。

Objective To investigate the prevalence rate of H. pylori in hepatitis B virus-relative liver disease patients, including chronic hepatitis B, hepatic carcinoma and cirrhosis. Methods A total of 273 patients with liver disease were selected and anti-H, pylori IgG was detected in their serum. Positive results meant that the patients were infected with Hp. Results The prevalence rates of H. pylori infection in patients with hepatitis B, HBV-related hepatic carcinoma and HBV-related liver cirrhosis were 62.7 %, 77.0 %, 79.7 % respectively. Significant difference was found between two groups（P〈 0. 001 ）, compared with healthy people. The prevalence rate of H. pylori infection in patients with HBV-related hepatic carcinoma and HBV-related liver cirrhosis was higher than that of H. pylori infection in patients with chronic Hepatitis B（P 〈 0.05）. The prevalence rate of H. pylori infection in positive patients with HBV DNA was higher than those negative patients, but the prevalence rate was similar in patients with different levels of HBV DNA. The prevalence rates d H. pylori infection in patients with Child-Pugh classes A, B, and C liver cirrhosis were 51. 9 %, 63.4 %, 65.6 %. There was no significant difference in patients with different grades of liver cirrhosis. Conclusion The prevalence rate of H. pylori infection in patients with chronic liver disease led by HBV is higher. The patients with hepatitis B who also have hepatic carcinoma or liver cirrhosis are more easily infected by Hp. The infection of Hp may have relationship with the complication of HBV-related liver diseases and Hp may have toxicity for hepatocyte.