幽门螺旋杆菌感染对非甾体类抗炎药相关性溃疡的影响

Effect of helicobacter pylori infection on nonsteroidal anti-inflammatory drugs related peptic ulcer

目的 探讨幽门螺旋杆菌（HP）感染对非甾体类抗炎药（NSAID）相关性溃疡的影响.方法 选取于中山大学孙逸仙纪念医院就诊,需长期（〉3个月）服NSAID的患者275例;服NSAID前所有患者均做^13C-尿素呼气试验（^13C-UBT）,选取结果 （＋）者共165例;165例患者均做电子胃镜,结果显示胃十二指肠无病变者132例.将132例纳入研究对象,随机分两组：HP根除组（组1）与非HP根除组（组2）,每组66例,每组按NSAID相关性溃疡的危险因素分高危人群和非高危人群.HP根除组口服NSAID前予口服三联抗HP药物治疗14 d,隔1个月后复查^13C-UBT,结果阴性者与非HP根除组均口服NSAID 3个月后复查胃镜,依据胃镜结果得出患消化性溃疡的例数.结果 HP根除组66例患者抗HP后复查^13C-UBT,其中2例仍呈（＋）,予排除.HP根除组64例患者发生消化性溃疡19例,发生率为28.6％;非根除HP组66例发生消化性溃疡31例,发病率为48.5％;两组消化性溃疡发生率比较差异有统计学意义（P〈0.05）.对高危人群,HP根除组消化性溃疡发生率为35.5％,非HP根除组消化性溃疡发生率为68.8％,两组发生率比较差异有统计学意义（P〈0.05）.结论 对需于长期服NSAID的HP阳性的患者,特别对于高危人群,开始服药前进行HP根除治疗,能明显减少NSAID相关性溃疡的发生.

Objective To investigate the effect of helicobacter pylori（HP）infection on peptic ulcer associated with nonsteroidal anti-inflammatory drugs（NSAID）. Methods A total of 275 patients who consulted in hospital and required to take NSAID for long-term（〉 3 months）all underwent 13 carbon urea breath test （^13C-UBT ）before taking NSAID. A total of 165 patients whose results of ^13C-UBT showed positive all done gastroscopy,and the gastroscopy results showed 132 patients had no disorders of stomath and duodenum. The 132 patients were randomly divided into two groups：eradicating HP group （group 1）and non eradicating HP group（group 2）,with 66 cases in each group. The 66 patients in each group were divided into high risk group and non high risk group according to risk factors of peptic ulcer associated with NSAID. Group 1 received tripe anti-HP therapy for 2 weeks before orally taking NI-SAID,and reexamined ^13C-UBT after 1 month. The patients whose results of ^13C-UBT showed negative and group 2 took NSAID for 3 months and redone gastroscopy. The number of patients who had peptic ul-cer was figured out according to the gastroscopy. Results Sixty-six patients in group 1 were reexamined with ^13C-UBT of which 2 patients still presented negative results and were removed. The incidence of peptic ulcer was 28. 6%（16 / 64）in group 1 and 48. 5%（31 / 66）in group 2,there was a signifinant difference between the two groups（P 〈 0. 05）. The incidence of peptic ulcer was 35. 5% in high risk group of group 1 and 48. 5% in high risk group of group 2,there was a signifinant difference between the two groups （P 〈 0. 05）. Conclusions For the patients required to take NSAID for long-term （〉 3 months）,espicially for the high risk group,receive tripe anti-HP therapy before take NSAID can signifi-nantly reduce the incidence of peptic ulcer.