125例2型糖尿病患者幽门螺杆菌感染现状及其对糖尿病胃轻瘫的影响

Prevalence of Helicobacter pylori infection in 125 patients with type 2 diabetes and its effects on diabetic gastroparesis

目的探讨2型糖尿病患者H．pylori感染现状及其对糖尿病胃轻瘫的影响。方法采用前瞻性临床病例对照研究方法，纳入2011年1月至2013年12月住院的125例2型糖尿病患者和同期的142名无消化不良症状的健康对照者。调查两组的H．pylori感染状况及糖尿病患者胃轻瘫的发生率。将2型糖尿病患者按照病程进行分组，分析各组合并胃轻瘫和H．pylori感染情况。对所有感染H．pylori的2型糖尿病患者和健康对照者进行H．pylori根除治疗，比较两组的根除率，并比较2型糖尿病患者治疗前后胃轻瘫症状的改善情况。统计学方法采用卡方检验。结果2型糖尿病组的H．pylori感染率为66．4％（83／125），高于健康对照组的51．4％（73／142），差异有统计学意义（χ^2=5．549，P〈0．05）。糖尿病病程〈10年，10～20年和〉20年患者的胃轻瘫发生率分别为33．8％（27／80）、47．1％（16／34）、8／11，差异有统计学意义（χ^2=6．554，P〈0．05）；且合并胃轻瘫患者的H．pylori感染率为78．4％（40／51），高于未合并胃轻瘫患者的58．1％（43／74），差异有统计学意义（χ^2=4．716，P〈0．05）。2型糖尿病患者的H．pylori根除率为68．7％（57／83），低于健康对照组的87．8％（36／41），差异有统计学意义（χ^2=4．385，P〈0．05）。2型糖尿病患者H．pylori根除治疗前的上腹胀痛、早饱和厌食的发生率分别为75．9％（63／83）、66．3％（55／83）和67．5％（56／83），根除治疗后分别为44．6％（37／83）、37．3％（31／83）和39．8％（33／83），差异均有统计学意义（χ^2=15．720、12．764、11．724，P均d0．01）。结论2型糖尿病患者H．pylori感染率升高，且糖尿病胃轻瘫的发生与H．pylori感染有关。2型糖尿病患者的H．pylori根除率较低，H．pylori根除治疗可有效改善糖尿病胃轻瘫患者的消化不良症状。

Objective To investigate the prevalence of Helicobacter pylori （H. pylori） infection in type 2 diabetic patients and its effects on diabetic gastroparesis. Methods Prospective clinical case-control study was applied. From January 2011 to December 2013, 125 hospitalized patients with type 2 diabetes and 142 healthy controls without dyspeptic symptoms were enrolled. The prevalence of H. pylori infection and the incidence of gastroparesis in 125 patients with diabetes were investigated in both two groups. The patients with type 2 diabetes were divided into groups according to the course of the disease, and the prevalence of gastroparesis and H. pylori infection of each group were analyzed. The patients with type 2 diabetes and healthy controls confirmed with H. pylori infection were treated with eradication therapy, the rate of eradication of two groups was compared. The improved symptoms of gastroparesis before and after eradication therapy of patients with type 2 diabetes were compared. The chi-square test was performed for statistical analysis. Results The prevalence of H. pylori infection in type 2 diabetic patients was 66.4% （83/125）, which was significantly higher than that of healthy control group （51.4%, 73/142） （χ^2=5. 549, P〈0.05）. The prevalence of gastroparesis in diabetic patients with the disease course less than 10 years, 10 to 20 years and more than 20 years was 33. 8% （27/80）, 47. 1% （16/34） and 8/11, respectively. The difference was statistically significant （χ^2 = 6. 554, P 〈0.05）. The prevalence of H. pylori infection in patients with gastroparesis was 78. 4% （40/51）, which was significantly higher than that of patients without gastroparesis （58.1%, 43/74） （7/2 = 4. 716, P〈0. 05）. The eradication rate of H. pylori infection in patients with type 2 diabetes was 68.7% （57/83）, which was lower than that of healthy control group （87.8%, 36/41）, and the difference was statistically significant （χ^2=4. 385, P（ 0.05）. The incidence of epigastric pain and distension, early satiety and apocleisis before H. pylori eradication in type 2 diabetes patients was 75. 9% （63/83）, 66. 3% （55/83） and 67. 5% （56/83）, respectively, while after eradication which was 44.6%（37/83）, 37.3%（31/83） and 39.8%（33/83） after eradication, respectively. The differences were statistically significant （χ^2 =15. 720, 12. 764 and 11. 724; all P〈0.01）. Conclusions The prevalence of H. pylori infection is significantly higher in type 2 diabetic patients, and gastroparesis in type 2 diabetic patients may be correlated with H. pylori infection. The eradication rate in type 2 diabetic patients was lower, and H. pylori eradication therapy can efficiently improve the symptoms of dyspepsia in diabetic patients with gastroparesis.