肝移植受者幽门螺杆菌感染诊治的临床实践

Helicobacter pylori infection in liver transplant recipients

目的分析肝移植受者幽门螺杆菌(Hp)感染的情况,并初步探讨肝移植术后Hp根除治疗的临床实践。方法以2018年7月至2019年10月青岛大学附属医院器官移植中心规律门诊随访的130例肝移植受者为研究对象,其中男性104例,女性26例,平均年龄52.1岁,纳入移植组。按年龄和性别1∶3进行倾向性评分匹配,纳入390例健康体检者,其中男性299例,女性91例,平均年龄51.8岁,纳入对照组。所有入选者均行^(13)C尿素呼气试验,分析肝移植受者Hp感染和四联疗法根除情况。结果肝移植受者^(13)C尿素呼气试验阳性率18.5%(24/130),低于对照组36.4%(142/390),差异有统计学意义(χ^(2)=14.400,P<0.001)。肝移植术后距^(13)C呼气试验<1年、1~3年及>3年的受者呼气试验阳性率分别为14.3%(6/42)、17.8%(8/45)、23.2%(10/43),呈升高趋势,但差异无统计学意义(χ^(2)=1.321,P=0.517)。共有17例(70.8%,17/24)Hp阳性肝移植受者接受根除Hp治疗,成功率为100.0%(17/17),其中10例受者完整监测治疗过程中免疫抑制剂的血药浓度,治疗过程中免疫抑制剂血药浓度是治疗前的1.7~3.6倍,免疫抑制剂减量至治疗前的1/3~1/2。7例受者出现头痛、高血压、失眠和情绪激动等药物相关不良反应。受者肝肾功能无明显波动。结论肝移植术后受者的Hp感染率为18.5%,四联疗法根除Hp治疗的效果较好,治疗过程中应注意调整免疫抑制剂剂量。

Objective To determine the prevalence of Helicobacter pylori(Hp)infection in orthotopic liver transplantation(LT)recipients,and to study the efficacy and safety of Hp eradication therapy.Methods ^(13)C-urea breath test was carried out between July 2018 and October 2019.There were 104 males and 26 females with an average age of 52.1 year for these LT recipients who were regularly followed-up in the Organ Transplant Center,the Affiliated Hospital of Qingdao University.Propensity scoring was used to match age and gender in a ratio of 1∶3.A healthy group of individuals consisting of 299 males and 91 females,with an average age of 51.8 years,were selected as the control group also in a ratio of 1∶3.All patients underwent ^(13)C-urea breath test to evaluate Hp infection and results of quadruple therapy.Results The prevalence of Hp infection among the LT recipients was 18.5%(24/130)which was significantly lower than the control group 36.4%(142/390)(χ^(2)=14.400,P<0.001).Among the recipients who received LT and ^(13)C-urea breath test for less than 1 year,1-3 years and more than 3 years,the prevalences of Hp infection were 14.3%(6/42),17.8%(8/45)and 23.3%(10/43),respectively.Although the prevalence of Hp showed a gradually increasing trend,no correlation between Hp infection and duration from LT was observed(χ^(2)=1.321,P=0.517).Seventeen Hp positive recipients underwent Hp eradication therapy.The success rate of Hp eradication was 100.0%(17/17).Immunosuppressant concentration was monitored regularly in 10 patients.During Hp eradication,the blood concentration of immunosuppressant increased from 1.7 to 3.6 times,and the drug dosage was reduced to one half to one third of what it was before Hp eradication.Seven of these 17 recipients suffered from adverse effects caused by increased levels of blood concentration of immunosuppressants,including headache,hypertension,insomnia and irritability.Normal liver and kidney functions were observed during eradication.Conclusion In this study,the prevalence of Hp infection among liver transplant recipients was 18.5%.The success rate of Hp eradication was 100%using bismuth-containing quadruple therapy.The dosage of immunosuppressant required to be monitored,and if necessary,adjusted during eradication to reduce adverse side effects.