老年患者幽门螺杆菌感染根除失败的原因

Causes of failed eradication of Helicobacter pylori infection in the elderly patients

目的探讨老年患者幽门螺杆菌(Hp)感染根除失败的原因。方法收集2017年1月至2018年6月期间在北京老年医院接受Hp根除治疗的年龄≥60岁患者200例。根除治疗完全停止后1个月以上复查碳13呼气试验,以根除失败者为研究组,共计36例患者Hp阳性。选取同期根除成功的40例患者为对照组。应用自制调查问卷调查所有患者一般社会状况、消化系统疾病、既往病史、是否多重用药、吸烟、饮酒、不良反应发生、根除方案、依从性、根除前是否服用抗生素、根除前是否服用质子泵抑制剂(PPI)以及Hp根除意愿。采用SPSS 17.0软件进行数据处理。依据数据类型,组间比较分别采用t检验或χ~2检验。logistic回归分析Hp根除失败的危险因素。结果多重用药(OR=0.102,95%CI 0.025～0.419;P=0.002)、依从性(OR=0.112,95%CI 0.016～0.779;P=0.027)、根除前是否服用PPI(OR=5.903,95%CI 1.193～29.215;P=0.030)和是否采用阿莫西林四联方案(OR=0.095,95%CI 0.012～0.744;P=0.025)与Hp根除成功与否独立相关。结论老年患者Hp感染应个体化、规范化治疗。

Objective To investigate the causes of the failed eradication of Helicobacter pylori(Hp)infection in the elderly.Methods Data were collected of 200 patients aged 60 years or older who underwent Hp eradication in Beijing Geriatric Hospital from January 2017 to June 2018.A carbon 13 breath test was performed on the follow-up visit at 1 month after the completion of the eradication treatment,36 patients who failed in the eradication with positive Hp were taken as study group,and 40 patients who were selected from those with successful eradication as control group.Using a self-developed questionnaire,data were collected of their social status,digestive diseases,past medical history,multiple drugs use,smoking,alcohol consumption,adverse reactions,eradication protocols,compliance,taking antibiotics or proton pump inhibitor(PPI)before eradication,and willingness for eradication.Data were processed with SPSS statistics 17.0.Depending on data type,t-test orχ^2 test was used for comparison.Logistic regression was performed for the analysis of risk factors for the failure of Hp eradication.Results Multiple drugs use(OR=0.102,95%CI 0.025-0.419;P=0.002),compliance(OR=0.112,95%CI 0.016-0.779;P=0.027),and taking PPI(OR=5.903,95%CI 1.193-29.215;P=0.030)or bismuth-based quadruple regimen with amoxicillin(OR=0.095,95%CI 0.012-0.744;P=0.025)before the eradication were independently associated with success of Hp eradication.Conclusion The treatment of Hp infection in the elderly should be individualized and standardized.