根除幽门螺杆菌对溃疡病及再感染的五年随访研究

Five-year follow-up study on the morbidity of peptic ulcer and H.pylori reinfection after H.pylori eradication.

目的 探讨根除幽门螺杆菌 (Hp)对消化性溃疡发病及复发的影响 ,并了解人群Hp根除5年后Hp感染的变迁。 方法 在胃癌高发区自然人群中随机抽样选择 10 0 6例成年人 ,将经胃镜活检病理及尿素酶检查Hp均阳性的 5 5 2例患者随机分为两组 ,采用随机、双盲、安慰剂对照平行试验 ,给予OAC(奥美拉唑、羟氨苄青霉素、克拉霉素 )口服治疗 1周。停药 1个月后行13 C 尿素呼气试验 (13 C UBT) ,Hp根除率为 88.89%。 1年及 5年后分别对上述人群进行胃镜随访 ,并行内镜活检病理WS染色及尿素酶检查。结果 ①在第 1年和第 5年实际进行胃镜追踪复查的应答率分别为 89.13%和 83.11%。②治疗组和对照组试验前消化性溃疡的发病率分别为 9.87%和 7.6 1% ,三联根除治疗 1年后分别为 3.70 %和 12 .85 % ,5年后为 5 .86 %和 14 .93%。复发率在 1年后分别为 3.70 %和 38.10 % ,5年后为 14 .81%和 4 2 .86 %。③治疗组 1年后Hp阳性率为 13.5 8% ,5年后为 19.82 % ,而对照组分别为91.97%和 83.2 6 %。结论 根除Hp治疗后 ,消化性溃疡的发病率及复发率明显降低。人群中Hp每年实际再感染率为 4 %～ 5 % ,5年间Hp感染状态保持稳定不变者占 85 % ,不稳定者占 15 %。

Objective To investigate the morbidity and Helicobacter pylori (H.pylori) reinfection status within 5 years after eradication. Methods One thousand and six adults aged between 35 to 37 were selected from general population in the high incidence region of gastric cancer. Among them, 552 individuals were confirmed to be H.pylori positive by both CLO test and Warthin Starry Stain histology. All the H.pylori positive individuals were randomly divided into two groups: treatment group receiving OAC triple therapy for one week and placebo group as controls. One month after cessation of treatment, the H.pylori eradication rate was 88.9%, while in the control group the H.pylori infection rate still remained 96.4% by 13 C UBT. These subjects were endoscopically followed up at the end of first and fifth years, respectively. H.pylori infected status was studied by histology and CLO test. Results 1. At 1 and 5 years after eradication, the response rates of subjects were 89.13% and 83.11%, respectively. 2. The morbidity rates of peptic ulcer, before treatment, were 9.87% and 7.61% in the treatment group and control group, respectively. At the 1st year, the morbidity rates were 3.70% and 12.85% in the two groups ( P <0.05); the recurrence rates were 3.70% and 38.10%, respectively ( P <0.05). At the 5th year, the morbidity rates were 5.86% and 14.93% ( P < 0.05) ; and the recurrence rates were 14.81% and 42.86%, respectively ( P <0.05). 3. In the treatment group, at 1st year after eradication the H.pylori positive rate was 13.58%, at 5th year it was 19.82%. In the control group, H.pylori positive rate was 91.97% at 1st year and 83.26% at 5th year. Conclusions 1. After H.pylori eradication the morbidity and recurrence rates of peptic ulcer markedly reduced in the treatment group. It is suggested that H.pylori infection is an important pathogenic factor of peptic ulcer disease. 2. After H.pylori eradication, the reinfection rate was 1.70% per year, and in the control group about 3.30% annually, so the actual reinfection rate should be 4%～5% yearly. 3. Subjects whose H.pylori infection status was kept stable during the period of follow up accounted for 85%, while subjects whose H.pylori infection status was altered accounted for 15% in this part of population.