幽门螺杆菌感染与膝骨关节炎病人非甾体类药物使用后上消化道出血的相关性分析

Relationship between Helicobacter pylori infection and upper gastrointestinal bleeding in patients with knee osteoarthritis after non-steroid anti-inflammatory drug treatment

目的探究幽门螺杆菌(Hp)感染与膝骨关节炎(KOA)病人非甾体类药物(NSAID)使用后上消化道出血的关系。方法选取2015年2月至2019年5月遂宁市中心医院收治的KOA病人223例作为研究对象。根据KOA病人是否感染Hp将病人分为Hp阳性组(161例)和Hp阴性组(62例),又将Hp阳性组分为Hp阳性治疗组(102例)和阳性未治疗组(59例),所有病人均采用常规塞来昔布胶囊(NSAID)治疗,Hp阳性治疗组均采用四联用药方案行Hp根除治疗。比较Hp阴性组、Hp阳性组临床资料;各组病人于治疗后1个月时随访,比较Hp阳性治疗组和阳性未治疗组病人Hp根治效果;比较各组上消化道出血情况、贫血、血红蛋白含量、谷丙转氨酶、血肌酐、凝血酶原时间;logistic回归分析上消化道出血的影响因素。结果Hp阳性组有吸烟史、消化道史的KOA病人比例分别为88/161、43/161,高于Hp阴性组的24/62、8/62(P<0.05);Hp阳性治疗组Hp阴性者比例、血红蛋白含量分别为96.08%、(129.87±4.96)g/L,高于Hp阳性未治疗组的0%、(121.92±2.45)g/L(P<0.05);Hp阳性治疗组Hp阳性者比例、上消化道出血者比例、贫血发生率分别为3.92%、1.96%、1.96%,低于Hp阳性未治疗组的100.00%、13.56%、10.17%(P<0.05);Hp阴性组病人黑便、呕血、粪便隐血阳性比例分别为0%、0%、0%,Hp阳性未治疗组病人黑便、呕血、粪便隐血阳性比例分别为11.86%、8.47%、10.17%,Hp阳性治疗组病人黑便、呕血、粪便隐血阳性比例分别为1.00%、0%、0%,差异有统计学意义(P<0.05);吸烟史、消化道出血史、Hp感染均为上消化道出血的独立危险因素(P<0.05)。结论抗Hp治疗可降低KOA合并Hp感染使用非甾体类药物病人上消化道出血风险,有利于改善贫血程度。

Objective To investigate the relationship between Helicobacter pylori(Hp)infection and upper gastrointestinal bleeding in patients with knee osteoarthritis(KOA)after non-steroid anti-inflammatory drug(NSAID)treatment.Methods Two hundred and twenty-three patients with KOA were selected as the study objects,who were admitted to Suining Central Hospital in Suining City of Sichuan Province from February 2015 to May 2019.According to whether KOA patients were infected with Hp or not,they were assigned into Hp positive group(n=161)and Hp negative group(n=62),and Hp positive group was further assigned into Hp positive treatment group(n=102)and Hp positive non-treatment group(n=59).All patients were treated with NSAID(celecoxib capsule)and Hp positive treatment group was treated with quadruple drug regimen for Hp eradication.The clinical data of Hp negative group and Hp positive group were compared;patients in each group were followed-up at 1 month after treatment,and the curative effects of Hp were compared between the Hp positive treatment group and the Hp positive non-treatment group.A comparison was made among groups of the bleeding,anemia,hemoglobin content,alanine aminotransferase,creatinine and prothrombin time of upper digestive tract and the influencing factors of upper gastrointestinal hemorrhage were analyzed by logistic regression.Results The proportions of KOA patients with smoking history and digestive tract disease history in Hp positive group were 88/161 and 43/161,respectively,higher than those in Hp negative group(24/62 and 8/62)(P<0.05).The proportion of Hp negative patients and hemoglobin content in the Hp positive treatment group were 96.08%and(129.87±4.96)g/L,respectively,which were higher than those in the Hp positive non-treatment group[0%and(121.92±2.45)g/L](P<0.05).The proportions of Hp-positive patients,upper gastrointestinal bleeding and anemia in the Hp-positive treatment group were 3.92%,1.96%,and 1.96%,respectively,which were lower than those in the Hp-positive non-treatment group(100.00%,13.56%,10.17%,respectively;P<0.05).There were significant differences in the proportions of melena,hematemesis,and fecal occult blood among the Hp negative group,Hp positive non-treatment and Hp positive treatment group(Hp negative group:0%,0%,and 0%;Hp positive non-treatment group:11.86%,8.47%,and 10.17%;Hp positive treatment group:1.00%,0%,and 0%);the differences were statistically significant(P<0.05).Smoking history,gastrointestinal bleeding history and Hp infection were all independent risk factors for upper gastrointestinal bleeding(P<0.05).Conclusion Anti-Hp treatment can reduce the risk of upper gastrointestinal bleeding in patients with KOA and Hp infection taking NSAID,and improve the degree of anemia in patients.