幽门螺杆菌根除效果影响因素分析

Factors associated with the efficacy of Helicobacter pylori eradication

目的探讨影响幽门螺杆菌（Helicobacter pylori，H．pylori）根除效果的因素，为人群干预和临床治疗提供依据。方法对2012年山东省临朐县九山镇1912名H．pylori感染阳性，经甲硝唑、四环素、铋剂和奥美拉唑治疗，且有完整服药依从性数据的研究对象，采用13C-尿素呼气试验（13C-urea breath test，13C-UBT）方法判定根除效果。系统收集年龄、性别、身高、体质量、职业、教育水平、吸烟和饮酒等信息。采用非条件logistic回归逐步法，筛选可能与H．pylori根除效果有关的影响因素。结果年龄（P=0．043）、性别（P〈0．001）、职业（P〈0．001）、吸烟情况（P〈0．001）、饮酒情况（P=0．002）及服药依从性（P漏服〈0．001，P带药=0．024）在根除成功与根除失败组间的分布差异有统计学意义。多因素分析发现，药物漏服者H．pylori根除失败的风险是无漏服者的4．26倍，95％cI为2．97～6．12；吸烟者是非吸烟者的1．73倍，95％CI为1．22～2．45；外出打工者是本地务农者的1．74倍，95％CI为1．20～2．51；基线超基准（deltaoverbaseline，DOB）值最高组是最低组的1．52倍，95％CI为1．09～2．12。按性别分层分析发现，男性漏服（0R=2．37，95％CI为1．28～4．42）及吸烟者（OR=1．64，95％c1为1．15～2．32）H．pylori根除失败差异均有统计学意义；女性漏服（OR=5．85，95％CI为3．73～9．18）及外出打工者（OR=2．67，95％CI为1．49～4．78）H．pylori根除失败差异均有统计学意义。联合作用分析发现，与不合任何影响因素者H．pylori根除率（87．1％）相比，无漏服但有其他影响因素（吸烟、职业和基线DOB值任意一种或一种以上的组合）者根除率为79．8％，只漏服者根除率为60．9％，而既漏服又有其他影响因素者根除率只有52％。结论服药依从性、职业、吸烟史以及DOB值影响H．pylori根除效果，提示在人群干预和临床治疗中，应尽量控制这些影响因素，以提高H．pylori根除率。

OBJECTIVE To explore factors associated with the efficacy of Helicobacter pylori （H. pylori） eradica- tion and provide evidences for improving clinical practices and population-based intervention trials. METHODS A total of 1 912 H. pylori-positive subjects who received quadruple anti- H. pylori treatment （ten days treatment with omeprazole 20 mg twice daily, tetracycline 750 mg three times daily, metronidazole 400 mg three times daily, and bismuth citrate 300 mg twice daily） with completed treatment compliance data were selected from Jiushan, Linqu County of Shandong Province,a rural area with high risk of gastric cancer. The efficacy of H. pylori eradication was determined by 13C-urea breath test （13 C-UBT） 45 days after the treatment. Information on age, gender, height, weight, occupation, education, smoking and drinking was obtained by a standard structured questionnaire. Odds ratios （ORs） and 95 % confidence inter- vals （CIs） were calculated by unconditional Logistic regression for factors associated with the efficacy of H. pylori eradi- cation. RESULTS Significant differences in age （P = 0. 043）, gender （P〈0. 001）, occupation （P〈0. 001）, smoking （P〈0. 001） ,drinking （P=0. 002） ,treatment compliance （missed dose P〈0. 001 ,drug taken P=0. 024） ,and delta over baseline （DOB） value of 13 C-UBT at baseline were observed between H. pylori successfully eradicated and unsuccessfully eradicated subjects. In comparison with H. pylori successfully eradicated ones, we found that H. pylori eradication failure was associated with missed doses （OR= 4.26,95 % CI： 2.97 -- 6.12）, smoking （OR= 1.73,95 % CI： 1.22 -- 2.45 ）, migrant work （OR=I. 74,95%CI： 1.20--2.51）,and high baseline DOB value （OR=I. 52,95%CI： 1.09--2. 12） respectively. The proportion of H. pylori eradication was 79.8% in subjects with any other risk factors （smoking,occupation and base- line DOB value） except for missed doses,60.9% in subjects with missed doses,and 52% in subjects with missed doses and any other risk factors,in contrast to 87.1 ~ in subjects without any related factors. CONCLUSIONS These findings suggest that missed doses,smoking,occupation,and baseline DOB value may influence the efficacy of H. pylori eradication. Therefore,smoking control and improving medication compliance should be recommended during H. pylori treatment.