老年高血压患者幽门螺杆菌感染与新发心脑血管事件关系的研究

Association between Hp infection and first cardio-cerebrovascular events in elderly hypertensive patients

目的 研究老年高血压患者幽门螺杆菌（helicobacter pylori,Hp）感染与新发心脑血管事件的相关性。方法选择在我院健康体检的老年高血压患者2084例,用13碳尿素呼气试验测Hp。患者根据检测结果分为Hp未感染组1208例（超基准值〈4.0）和Hp感染组876例（超基准值≥4.0）。平均随访（3.5±0.5）年,随访期,每6个月电话或门诊随访1次,收集新发心脑血管事件情况。分析Hp感染对老年高血压患者新发心脑血管事件的影响。结果 Hp感染组新发总心脑血管事件（9.25%vs 3.56%）、脑梗死（4.11%vs 2.07%）和非致死性急性心肌梗死（3.65%vs 1.08%）发生率均高于Hp未感染组,差异有统计学意义（P〈0.05,P〈0.01）;多变量Cox比例风险回归分析校正相关因素后,Hp感染组患者发生总心脑血管事件、脑梗死和心肌梗死的相对危险分别为Hp未感染组患者的2.82倍（95%CI：2.11~3.27,P=0.002）,1.85倍（95%CI：1.26~2.53,P=0.013）和3.26倍（95%CI：1.41~3.99,P=0.001）,Hp感染是老年高血压患者发生临床心脑血管事件的一个独立危险因素。结论 Hp感染参与动脉粥样硬化的进程,老年高血压患者Hp感染可增加发生临床心脑血管事件的危险。

Objective To study the association between Hp infection and first cardio-cerebrovascular events in elderly hypertensive patients. Methods Hp were detected in 2084 elderly hyper tentive patients undergoing physical examination in our hospital by 13C urea breath test. The pa tients were divided into non-Hp infection group （n=1208 with their bseline value〈4.0） and Hp infection group （n=876 with their baseline value≥4.0）. The patients were followed up for 3.5± 0.5 years,during which the first cardio cerebrovascular events were recorded every 6 months. The effect of Hp infection on first cardio cerebrovascular events in elderly hypertentive patients was analyzed. Results The incidence of first cardio cerebrovascular events, cerebral infarction and non fetal AMI was significantly higher in Hp infection group than in non-Hp infection group （P〈0. 05,P〈0. 01）. After adjustment for related factors, multivariate Cox proportional hazards re- gression analysis showed that the incidence of cardio-cerebrovascular events, cerebral infarction and non-fetal acute myocardial infarction was 2.82 , 1.85- and 3.26 fold higher in Hp infection group than in non-Hp infection group （RR=2.82,95%CI：2. 11-3. 27,P=0. 002：RR=1. 85, 95%CI：1.26--2.53,P=0.013;RR 3.26,95%UI：1. 41-3.99,P=0. 001）,indicating that Hp infection is an independent risk factor for cardio-cerebrovascular events in elderly hypertensive pa tients. Conclusion Hp infection is involved in atherosclerosis and is associated with the increased risk of first cardio cerebrovascular events in elderly hypertensive patients.