二甲双胍对2型糖尿病患者幽门螺杆菌根除率的影响及其与血清白介素-8水平的关系

Effect of metformin on eradication rate of Helicobacter pylori in type 2 diabetic patients and its relationship with serum interleukin-8 level

目的分析二甲双胍对2型糖尿病(T2DM)伴有幽门螺杆菌(H.pylori)感染患者H.pylori根除率的影响以及其与血清白介素-8(IL-8)水平的潜在关系。方法选取徐州医科大学附属淮安医院2018年1月至2019年11月收治的100例T2DM伴有H.pylori感染患者为研究对象,按数字随机表法分为A组和B组各50例;另纳入同期收治的单纯性H.pylori感染患者50例为C组。3组患者均采用四联(阿莫西林+克拉霉素缓释片+奥美拉唑+胶体果胶铋)疗法抗H.pylori治疗,A组在此基础上使用二甲双胍联合胰岛素治疗,B组在此基础上仅给予胰岛素治疗,比较3组H.pylori根除率和不良反应的差异。同时按数字随机表法从3组中随机抽取20例患者,采取酶联免疫吸附法检测患者抗H.pylori治疗前的血清IL-8水平。采用χ2检验比较3组研究对象H.pylori根除率、不良反应发生率的差异;采用方差分析比较IL-8水平的差异,组间两两比较采用q检验。对H.pylori感染根除率的影响因素采用二项Logistic回归分析进行探讨。结果A组H.pylori根除率[94.00%(47/50)]高于B组[78.00%(39/50)]和C组[80.00%(40/50)],差异均具有统计学意义(χ^2=5.316,P=0.021;χ^2=4.332,P=0.037),而B组和C组比较,差异无统计学意义(χ^2=0.060,P=0.806)。使用二甲双胍组(A组)与未使用二甲双胍组(B组和C组)不良反应(恶心呕吐、低血糖、腹部不适及便秘症状)发生率比较,差异均无统计学意义(P>0.05)。A组血清IL-8水平低于B组和C组,[(163.02±22.11)pg/mL vs(294.00±29.89)pg/mL vs(306.11±35.17)pg/mL],A组分别与B组和C组血清IL-8水平比较,差异均具有统计学意义(q=4.172、4.797,P=0.005、0.001);B组与C组血清IL-8水平比较,差异无统计学意义(q=0.386,P=0.786)。Logistic回归分析结果发现,二甲双胍是H.pylori感染根除率的影响因素(OR=0.195,95%CI 0.051~0.748,P=0.017)。结论二甲双胍是影响H.pylori根除率的影响因素,它可以提高T2DM合并H.pylori感染患者的H.pylori根除率,并且可以降低血清IL-8水平;二甲双胍辅助抗H.pylori四联疗法,并不会显著增加不良反应的发生率。

Objective To analyze the effect of metformin on the eradication rate of Helicobacter pylori(H.pylori)in patients with type 2 diabetes mellitus and the potential relationship between metformin use and serum interleukin-8(IL-8).Methods One hundred patients with T2DM complicated with H.pylori infection admitted to Huai′an Hospital of Xuzhou Medical University from January 2018 to November 2019 were randomly divided into either group A(n=50)or group B.In addition,50 patients with H.pylori infection alone admitted in the same period were included in group C.All the patients in three groups were treated with quadruple therapy(amoxicillin,clarithromycin sustained release tablets,omeprazole,and colloidal pectin bismuth).On this basis,group A was treated with metformin combined with insulin,while group B was treated with insulin only.The eradication rate and adverse reactions in the three groups were compared.Meanwhile,20 patients were randomly selected from the three groups,and serum IL-8 levels were detected by enzymelinked immunosorbent assay.The Chi-square test was used to compare the eradication rate of H.pylori and the incidence of adverse reactions in the three groups.Analysis of variance was used to compare IL-8 levels,and q-test was used for pairwise comparison between groups.The factors affecting the eradication rate of H.pylori were investigated by binomial Logistic regression analysis.Results The H.pylori eradication rate in group A[94.00%(47/50)]was significantly higher than those in group B[78.00%(39/50)]and group C[80.00%(40/50)](χ^2=5.316,P=0.021;χ^2=4.332,P=0.037),while there was no statistical difference between group B and group C(χ^2=0.060,P=0.806).There was no statistically significant difference in the incidence of adverse reactions(nausea,vomiting,hypoglycemia,abdominal discomfort,and constipation)between the metformin group(group A)and the groups without metformin(group B and group C).Serum IL-8 level in group A was significantly lower than those of group B and group C[(163.02±22.11)pg/ml vs(294.00±29.89)pg/ml and(306.11±35.17)pg/ml;q=4.172 and 4.797;P=0.005 and 0.001,respectively],although there was no significant difference between group B and group C(q=0.386,P=0.786).Logistic regression analysis showed that metformin was a factor affecting the eradication rate of H.pylori(OR=0.195,95%CI=0.051-0.748,P=0.017).Conclusion Metformin is the potential influential factor of the H.pylori eradication rate,and it increases the H.pylori eradication rate in T2DM patients with H.pylori infection,and decreases serum IL-8 level.Metformin-added anti-Hp quadruple therapy does not increase the incidence of adverse effects.