幽门螺杆菌感染对老年2型糖尿病患者糖脂代谢及胰岛功能的影响

Influence of Helicobacter pylori infection on glycolipid metabolism and insulin function in elderly patients with type 2 diabetes mellitus

目的探讨老年2型糖尿病患者幽门螺杆菌(Helicobacter pylori, Hp)感染情况及其对糖脂代谢、胰岛功能的影响。方法 320例老年2型糖尿病患者,均行13C呼气试验,记录Hp感染情况,并将320患者分为Hp感染组和Hp未感染组。比较2组血清总胆固醇(total cholesterol, TC)、三酰甘油(triacylglycerol, TG)、高密度脂蛋白胆固醇(high-density lipoprotein cholesterol, HDL-C)、低密度脂蛋白胆固醇(low-density lipoprotein cholesterol, LDL-C)、糖化血红蛋白(glycated hemoglobin, HbA1c)、空腹血糖(fasting plasma glucose, FPG)、餐后2 h血糖(2 h postprandial plasma glucose, 2hPG)、空腹胰岛素(fasting insulin, FINS)及稳态模型胰岛素抵抗指数(homeostasis model assessment of insulin resistance, HOMA-IR)、尿微量白蛋白肌酐比(urinary microalbumin-creatinine ratio, ACR)、颈动脉内中膜厚度(intima-media thickness, IMT);多因素logistic回归分析老年2型糖尿病患者发生Hp感染的影响因素。结果 320例中Hp感染132例,感染率为41.3%;Hp感染组血清TC[(4.89±1.10)mmol/L]、TG[(2.12±0.86)mmol/L]、LDL-C[(3.11±1.03)mmol/L]、FPG[(9.29±3.05)mmol/L]、2hPG[(14.52±2.38)mmol/L]、HbA1c[(8.30±1.59)%]、FINS[(12.08±2.38)u/L]、HOMA-IR(5.76±0.79)、ACR[(86±14)mg/g]均高于Hp未感染组[(4.32±1.35)mmol/L、(1.93±0.39)mmol/L、(2.73±0.90)mmol/L、(8.04±1.87)mmol/L、(10.25±1.88)mmol/L、(7.57±0.92)%、(18.72±3.29)u/L、4.25±0.98、(54±10)mg/g](P<0.05),颈动脉IMT[(1.3±0.4)mm]较Hp未感染组[(0.9±0.3)mm]增厚(P<0.05),HDL-C[(1.05±0.20)mmol/L]水平较Hp未感染组[(1.41±0.25)mmol/L]降低(P<0.05);多因素logistic回归分析结果显示,FINS(OR=2.778, 95%CI:2.156~3.400,P=0.001)、HbA1c(OR=3.621, 95%CI:2.895~4.342,P<0.001)和HOMA-IR(OR=2.084, 95%CI:1.485~2.658,P=0.002)是老年2型糖尿病患者发生Hp感染的影响因素。结论老年2型糖尿病患者Hp感染率较高,发生Hp感染者胰岛素抵抗、糖脂代谢紊乱、动脉粥样硬化程度加重。FINS、HbA1c、HOMA-IR与老年2型糖尿病患者发生Hp感染有关。

Objective To evaluate the prevalence of Helicobacter pylori(Hp) infection and to observe its impact on glycolipid metabolism and insulin function in elderly patients with type 2 diabetes mellitus. Methods Totally 320 elderly patients with type 2 diabetes mellitus underwent 13C breath test to detect Hp infection, and were divided into Hp infection group and non-infection group. These two groups were compared the total cholesterol(TC), triacylglycerol(TG), high-density lipoprotein cholesterol(HDL-C), low-density lipoprotein cholesterol(LDL-C), glycated hemoglobin(HbA1c), fasting plasma glucose(FPG), 2 h postprandial plasma glucose(2 hPG), fasting insulin(FINS), homeostasis model assessment of insulin resistance(HOMA-IR), urinary microalbumin-creatinine ratio(ACR) and carotid intima-media thickness(IMT). Multivariate logistic regression analysis was performed to assess the risk factors for Hp infection in patients with type 2 diabetes mellitus. Results In 320 patients, 132 were infected with Hp, with the infection rate of 41.3%. The levels of TC((4.89±1.10) mmol/L), TG((2.12±0.86) mmol/L), LDL-C((3.11±1.03) mmol/L), FPG((9.29±3.05) mmol/L), 2 hPG((14.52±2.38) mmol/L), HbA1c((8.30±1.59)%), FINS ((12.08±2.38)u/L),HOMA-IR(5.76±0.79),ACR((86±14)mg/g)and IMT((1.3±0.4)mm)in Hp infection group were significantly higher than those in non-infection group((4.32±1.35)mmol/L,(1.93±0.39)mmol/L,(2.73±0.90)mmol/L,(8.04±1.87)mmol/L,(10.25±1.88)mmol/L,(7.57±0.92)%,(18.72±3.29)u/L,4.25±0.98,(54±10)mg/g,(0.9±0.3)mm)(P<0.05),while HDL-C((1.05±0.20)mmol/L)was lower than that in non-infection group((1.41±0.25)mmol/L)(P<0.05).Multivariate logistic regression analysis showed that FINS(OR=2.778,95%CI:2.156-3.400,P=0.001),HbA1 c(OR=3.621,95%CI:2.895-4.342,P<0.001),and HOMA-IR(OR=2.084,95%CI:1.485-2.658,P=0.002)were the influencing factors for Hp infection in elderly patients with type 2 diabetes mellitus.Conclusion Hp infection rate is high in elderly patients with type 2 diabetes mellitus.Hp infection can aggravate insulin resistance,glycolipid metabolism disorder and atherosclerosis in elderly patients,while FINS,HbA1 c and HOMA-IR are associated with Hp infection in elderly patients with type 2 diabetes mellitus.