2型糖尿病患者幽门螺杆菌再感染因素分析

Analysis of the influencing factors of helicobacter pylori reinfection in patients with type 2 diabetes

目的研究2型糖尿病(T2DM)患者四联抗幽门螺杆菌(HP)根除治疗48周后再感染影响因素。方法纳入我院内分泌科住院的T2DM患者179例,经13C尿素呼气试验检测HP阳性者108例,予以患者四联抗HP治疗2周,停药后4周复查HP阴性者97例继续随访,48周时再次复查HP;根据48周复测结果分为HP再感染阳性(H P阳性)组与HP再感染阴性(H P阴性)组。比较2组年龄、性别、体质量指数(BMI)、糖化血红蛋白(H bA1c)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)、总胆固醇(TC)、高密度脂蛋白胆固醇(H DL-C)、血尿酸(U A)、糖尿病(D M)病程、是否使用胰岛素、月收入≥3000元、吸烟史及饮酒史等指标的差异;探讨各个变量对HP再感染的影响。结果 T2DM患者中HP感染率为60.3%( 108/179);4周时HP根除率为89.8%( 97/108), 48周时HP再感染率为23.7%( 23/97);HP阳性组的DM病程、HbA1c均高于HP阴性组,HP阴性组的月收入≥3000元患者比例高于HP阳性组(P< 0.05);余指标2组差异无统计学意义(P> 0.05)。二分类Logistic回归分析结果显示,DM病程较长(OR=1.195, 95%C:I1.049~1.136)、 HbA1c升高(OR=1.293, 95%CI1.011~1.518)是 HP再感染的危险因素。结论在T2DM人群中存在HP再感染,DM病程越长及HbA1c越高者HP再感染可能性越大。

Objective To analyze the influencing factors of helicobacter pylori (HP) reinfection in patients with type 2 diabetes mellitus (T2DM) 48 weeks after a successful standard eradicating treatment. Methods A total of 179 T2DM patients from endocrine department of our hospital were included in our study. Among them 108 patients were evaluated HP infection by means of 13C-Urea Breath Test. All positive patients were eradicated by means of a standard quadruple therapy for 2 weeks. The eradication of HP was confirmed by means of 13C-Urea Breath Test performed at least four weeks after therapy, and 97 patients were successfully eradicated. After 48 weeks of follow-up, 97 patients underwent another 13C-Urea Breath Test. It was found that 74 out of 97 patients were negative and 23 positive for HP reinfection. The clinical data of 97 patients were collected and compared between two groups (HP negative group and HP positive group), including age, sex, body mass index (BMI), hemoglobin A1c (HbA1c), triglyceride (TG), low density lipoprotein cholesterol (LDL-C), total cholesterol (TC), high density lipoprotein cholesterol (HDL-C), Uric acid (UA), the duration of diabetes mellitus (DM), insulin usage, socio-economic status (monthly income ≥ 3 000 yuan) and the history of smoking and drinking. The effects of these variables on HP reinfection were also evaluated. Results The prevalence of HP was 60.3%(108 / 179). The eradication rate of HP was 89.8%(97/108). The reinfection rate was 23.7%(23/97) after 48-week of follow-up. The duration of DM and the level of HbA1c were significantly higher, and the proportion of patients with monthly income ≥3 000 yuan was significantly lower in HP positive group than those of HP negative group (P< 0.05). There were no significant differences in other indexes between two groups (P> 0.05). Binary logistic regression analysis showed that the duration of DM (OR=1.195, 95%CI 1.049-1.136) and the level of HbA1c (OR=1.293, 95%CI 1.011~1.518) were risk factors of HP reinfection. Conclusion According to our data, there is HP reinfection in T2DM patients. The long duration of DM and high level of HbA1c are associated with HP reinfection.