根除幽门螺杆菌感染及血糖控制与糖尿病胃轻瘫症状改善的关系

Curative effect of Helicobacter pylori eradication and glycaemia control on diabetic gastroparesis

目的 本研究旨在探讨根除幽门螺杆菌（Helicobacter pylori,Hp）及血糖水平对糖尿病患者胃轻瘫症状的改善及影响因素。方法 选择2012年3月~2014年6月于我科住院行Hp检测阳性的糖尿病患者424例,并行胃排空试验按是否有胃轻瘫分为A组及B组。采用标准抗Hp治疗,治疗后评估Hp根除疗效及胃轻瘫症状缓解情况。比较两组血糖水平,幽门螺杆菌根除率,以及不同血糖水平的患者幽门螺杆菌根除率及胃轻瘫症状缓解率。结果（1）与Hp阳性无胃轻瘫的糖尿病患者（B组）相比,Hp阳性合并胃轻瘫的糖尿病患者（A组）病程较长,空腹血糖、餐后2 h血糖及糖化血红蛋白（glycated hemoglobin A1c,Hb A1c）水平均较高（P均〈0.05）;（2）Hp阳性合并胃轻瘫的糖尿病患者的Hp根除率为68.70%,成功根除后的患者胃轻瘫症状缓解率为77.51%,而未根除的糖尿病患者胃轻瘫症状缓解率仅为53.25%,两组比较差异有统计学意义（P〈0.05）;（3）将Hp阳性合并胃轻瘫的糖尿病患者按Hb A1c水平分为三组,结果显示随着HbA1c水平的升高,Hp根除率下降,胃轻瘫症状改善率亦下降（P〈0.05）。结论 Hp根除对胃轻瘫症状改善有一定帮助,而血糖水平可影响Hp根除率及胃轻瘫症状的改善。

Objective To explore the clinical effect of H. pylori eradication and glycaemia control on diabetic gastroparesis. Methods A total of 424 patients infected with H. pylori which was confirmed under treatment in endocrine department from Mar 2012 to Jun 2014 were divided into two groups as A and B according to the gastric emptying test. Each subject accepted standard H. pylori eradication treatment and the variety of clinical symptoms were observed before and after treatment. We compared the glucose levels, the eradication rate and the remission rate between the two groups and among different glycaemia levels. Results （1） Diabetic history, fasting glucose（FPG）, 2 hour postprandial glucose（2hPG）, and glycated hemoglobin Alc（HbAlc） levels of patients with both H. pylori infection and diabetic gastroparesis（group A） were significantly longer and higher （all P〈0.05）than patients with H. pylori infection but without diabetic gastroparesis （group B）. （2） The H. pylori eradication rate of group A was 68.70%. The gastroparesis remission rate of those who successfully eradicated was 77.51%, which was significantly higher than those who failed to eradicate whose remission rate was only 53.25% （P〈0.05）. （3） Group A was further divided into three groups according to HbAlc levels, and results showed that as HbAlc levels increased, both the H. pylori eradication rate and the gastroparesis relief rate decreased（P〈0.05）. Conclusion There are some curative effect of H. pylori eradication on diabetic gastroparesis, while glucose levels could influence H. pylori eradication rate and gastroparesis symptoms improvement.