口腔幽门螺杆菌感染对胃内幽门螺杆菌根除疗效的影响及其相关因素研究

Influence and Related Factors for Helicobacter Pylori Infection of Oral Cavity on the Efficacy of Gastric Helicobacter Pylori Eradication

目的探讨口腔幽门螺杆菌(Hp)感染对胃内Hp根除疗效的影响,并探讨口腔Hp感染的相关因素。方法选取2011年12月—2012年9月航天中心医院诊治的胃溃疡、十二指肠溃疡、慢性胃炎患者92例为研究对象。根据唾液Hp测定试剂盒(胶体金法)检测结果分为口腔Hp阳性组54例和口腔Hp阴性组38例,两组患者均给予雷贝拉唑钠肠溶胶囊+枸橼酸铋钾胶囊+阿莫西林克拉维酸钾+克拉霉素片四联方案根除治疗10 d,停药4周后,采用^(13)C-尿素呼气试验检测胃内Hp根除率,研究口腔Hp感染对胃内Hp根除率的影响。同时采用《患者口腔疾病及卫生状况问卷》调查,明确口腔疾病及卫生状态对口腔Hp感染的影响。结果口腔Hp阳性组54例,胃内Hp根除43例,胃内Hp未根除11例,胃内Hp根除率为79.6%;口腔Hp阴性组38例,胃内Hp根除32例,胃内Hp未根除6例,胃内Hp根除率为84.2%。两组患者胃内Hp根除率比较,差异无统计学意义(χ~2=0.311,P=0.577)。是否有口腔异味(口臭)、义齿者口腔Hp感染率比较,差异均有统计学意义(P<0.05);是否有龋齿、缺齿、牙周炎、牙线使用、洗牙者口腔Hp感染率比较,差异均无统计学意义(P>0.05);不同刷牙习惯者口腔Hp感染率间差异亦无统计学意义(P>0.05)。结论口腔Hp感染对胃内Hp根除率未见明显影响,口腔Hp感染的临床意义尚需进一步深入研究;口腔异味(口臭)、义齿可能与口腔Hp感染相关;龋齿、缺齿、牙周炎、刷牙习惯、牙线使用、洗牙6个因素对口腔Hp感染未见明显影响,需扩大样本量进一步深入研究。

Objective To study the influence of Helicobacter pylori（ Hp）infection in oral cavity on gastric Hp eradication and its related factors. Methods We enrolled 92 patients with gastric ulcer,duodenal ulcer and chronic gastritis who were treated in Aerospace Center Hospital from December 2011 to September 2012. The patients were divided into oral Hp positive group and oral Hp negative group by Hp saliva test. The two groups were given 10 days of quadruple eradication therapy （rabeprazole sodium enteric - coated capsules,bismuth potassium citrate capsules,amoxicillin clavulanate potassium dispersible tablets and clarithromycin tablets）. After 4 weeks of complete drug withdrawal,the Hp eradication efficiency in stomach was detected by 13 C - urea breath test,then the relationship between Hp infection in oral cavity and Hp eradication rate in stomach was studied. Meanwhile,according to oral diseases and oral health questionnaire survey,the influence of oral diseases and health status on Hp infection in oral cavity was explored. Results The stomach Hp eradication rate was 79. 6% （43 / 54） in oral Hp positive group and was 84. 2% （32 / 38）in oral Hp negative group ,the difference between two groups was not statistically significant（ χ^2 = 0. 311,P = 0. 577）. Patients with mouth odor and dentures were statistically significantly from patients without mouth odor and dentures in oral Hp infection rate（ P 〈 0. 05）. Patients with decayed tooth,missing tooth, periodontitis,tooth brushing habit,flossing and scaling were not significantly different from patients without those in oral Hp infection rate（P 〉 0. 05）. Conclusion Oral Hp infection does not have remarkable influence on the Hp eradication rate in the stomach,thus the clinical of oral Hp infection needs to be further researched. Mouth odor and dentures may be related with oral Hp infection. Decayed tooth,missing teeth,periodontitis,tooth brushing habit,flossing,scaling have no noted influence on oral Hp infection,thus larger samples are needed to conduct further study.