根除幽门螺杆菌对非糖尿病患者胰岛素抵抗相关因素及血脂水平的影响

The effects of Helicobacter pylori eradication on insulin resistance and serum lipids in non-diabetes patients

目的探讨根除幽门螺杆菌(Hp)对非糖尿病患者空腹血糖(FBG)、空腹胰岛素(FINS)、胰岛素抵抗(IR)、血脂水平及体质量指数(BMI)的影响,为Hp感染相关代谢性疾病的临床防治提供理论依据。方法 98例经14C-尿素呼气试验确诊为Hp现症感染的非糖尿病患者予含铋剂四联方案根除Hp治疗(雷贝拉唑钠肠溶胶囊10mg bid+胶体果胶铋剂颗粒0.15g qid+阿莫西林胶囊1.0g bid+盐酸左氧氟沙星胶囊0.2g bid,疗程2周),治疗后1月复查14C-尿素呼气试验,分为Hp根除组和Hp未根除组。分别对每组患者治疗前后空腹血糖(FBG)、空腹胰岛素(FINS)、胰岛素抵抗指数(HOMAIR)、总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白(HDL-C)、低密度脂蛋白(LDL-C)及体质量指数(BMI)进行比较。结果 98例非糖尿病患者中62例Hp根除,36例Hp未根除,根除率63.3%。62例根除组患者治疗前后FBG、FINS、HOMA-IR分别为(5.33±0.40)mmol/L和(5.16±0.40)mmol/L、(11.21±6.28)u IU/m L和(10.71±5.08)u IU/m L、(2.73±1.61)和(2.60±1.45),差异具有统计学意义(P均<0.05),而Hp根除组TG、TC、LDL-C、HDL-C及BMI治疗前后,无统计学差异(P均>0.05)。Hp未根除组所有观察指标FBG、FINS、TG、TC、LDL-C、HDL-C、HOMA-IR及BMI治疗前后比较,差异无统计学意义(P均>0.05)。结论根除幽门螺杆菌能够改善非糖尿病患者胰岛素抵抗状态、空腹血糖及空腹胰岛素水平,但不影响非糖尿病患者体质量指数及血脂水平。

Objective To evaluate the effects of Helicobacter pylori（ Hp） eradication on fasting blood glucose（ FBG）,fasting insulin（ FINS）,resistance insulin（ IR）,body mass index（ BMI）,and lipid levels in non-diabetes patients,and provide the insight for clinic intervention. Methods 98 patients with the confirmed diagnosis of Hp infection by^14C-urea breath test were enrolled in this study. The patients with H. pylori were given quadruplet eradication treatment（ sodium rabeprazole enteric-coated capsules 10 mg bid ＋ colloidal bismuth Pectin particles 0. 15 g qid ＋ amoxicillin capsule 1. 0 g bid ＋ levofloxacin capsules 0. 2 g bid,for 2 weeks）. After one month treatment,these patients were categorized into H. pylori eradicated group and uneradicated group by^14C-urea breath test,and further assessed for fasting blood glucose（ FBG）,fasting insulin（ FINS）,insulin resistance index（ HOMA-IR）,total cholesterol（ TC）,triglyceride（ TG）,high density lipoprotein（ HDL-C）,body mass index（ BMI） and low-density lipoprotein（ LDL-C） levels. Results Among the 98 non-diabetes patients,62 cases were H. pylori eradicated and 36 cases were not H. pylori eradicated. The eradication rate was 63. 3%. In the eradicated group,FBG,FINS,HOMA-IR were significantly decreased after clearance of H. pylori infection（ P〈0. 05）,while there was no significant difference in TC,TG,LDL-C,HDL-C and BMI levels before and after eradication（ P〈0. 05）. In the uneradicated group,there was no obvious change in the indicators（ P〈0. 05）. Conclusion Eradication of H. pylori in non-diabetes patients improves the insulin resistance,fasting glucose,fasting insulin levels,but not affects the body mass index and blood lipid levels.