青海地区幽门螺杆菌感染情况和危险因素分析

Prevalence and risk factors of Helicobacter pylori infection in Qinghai Province

目的对青海地区开展幽门螺杆菌(H.pylori)感染省内多中心横断面研究调查和危险因素分析。方法2021年5至12月,通过青海大学附属医院、青海红十字医院、青海仁济医院等20家医疗中心对西宁市城区,海东农业区,以及海南藏族自治州、海北藏族自治州、玉树藏族自治州牧业区采取多中心分层抽样,对健康体检人群开展问卷调查。问卷内容包括一般资料、生活习惯、家族史等。对受检者进行^(13)C-尿素呼气试验以诊断有无H.pylori感染。统计学方法采用卡方检验、趋势卡方检验、卡方分割法和多因素logistic回归分析。结果青海地区H.pylori总感染率为53.6%(2531/4724)。H.pylori感染人群年龄分布差异有统计学意义(χ^(2)=15.95,P=0.007),15~<30岁人群感染率高于60~<75岁人群[57.6%(626/1086)比49.5%(231/467)],差异有统计学意义(χ^(2)=8.83,P=0.003);随年龄增长,30岁以上女性感染率呈下降趋势(χ^(2)_(趋势)=5.89,P=0.015)。不同民族间H.pylori感染率比较差异有统计学意义(χ^(2)=28.13,P<0.001),藏族人群感染率高于汉族[62.9%(313/498)比51.5%(1804/3503)],差异有统计学意义(χ^(2)=22.56,P<0.001);居住地海拔>3500 m的人群H.pylori感染率高于1500~3500 m人群[61.8%(327/529)比52.5%(2204/4195)],差异有统计学意义(χ^(2)=16.25,P<0.001)。与无相应习惯的人群相比,吸烟人群[62.1%(1081/1740)比48.6%(1450/2984)],以及常食手抓羊肉[55.4%(967/1744)比52.5%(1564/2980)]、生蒜[55.5%(968/1744)比52.4%(1563/2980)]、辛辣食物[55.6%(1471/2647)比51.0%(1060/2077)]、甜食[55.2%(1187/2149)比52.2%(1344/2575)]人群感染率较高,差异均有统计学意义(χ^(2)=80.94、3.89、9.63、4.36、4.13,均P<0.05),而饮茶[50.5%(1135/2247)比56.4%(1396/2477)]人群感染率较低,差异有统计学意义(χ^(2)=16.19,P<0.001)。多因素logistic回归分析显示,藏族(OR=1.379,95%置信区间1.120~1.699)、回族(OR=1.362,95%置信区间1.117~1.662)、居住地海拔>3500 m(OR=1.355,95%置信区间1.107~1.657)、吸烟(OR=1.847,95%置信区间1.629~2.094)、常食辛辣食物(OR=1.224,95%置信区间1.084~1.382)是H.pylori感染的独立危险因素(均P<0.05)。结论青海地区H.pylori感染率目前高于中国内陆地区平均水平。不同年龄、民族、居住地海拔、职业、生活饮食习惯人群感染率存在差异。30岁以上女性感染率呈逐年下降趋势。回族、藏族、常食辛辣食物、吸烟、居住地海拔>3500 m人群H.pylori感染风险较高。

Objective To investigate the prevalence and the risk factors of Helicobacter pylori(H.pylori)infection in Qinghai Province with a multi-center cross-sectional study.Methods From May to December in 2021,stratified sampling was conducted in Xining City,Haidong agricultural district,Hainan Tibetan Autonomous Prefecture,Haibei Tibetan Autonomous Prefecture and Yushu Tibetan Autonomous Prefecture by 20 centers,including the Affiliated Hospital of Qinghai University,Qinghai Red Cross Hospital and Qinghai Renji Hospital,etc.A questionnaire survey was carried out among the individuals undergoing routine health checkups.The questionnaire included general information,lifestyle and family history,etc.^(13)C-urea breath test was performed to diagnose H.pylori infection.Chi-square test,trend Chi-square test,segmentation method and multivariate logistic regression analysis were performed for statistical analysis.Results The infection rate of H.pylori in Qinghai area was 53.6%(2531/4724).The age distribution of infection was statistically significant(χ^(2)=15.95,P=0.007),the infection rate in individuals aged 15 to<30 was higher than that of individuals aged 60 to<75(57.6%,626/1086 vs.49.5%,231/467),and the difference was statistically significant(χ^(2)=8.83,P=0.003).With the increase of age,the infection rate decreased in female over 30 years old(χ^(2)trend=5.89,P=0.015).There were statistically significant differences in H.pylori infection rate among different ethnic groups(χ^(2)=28.13,P<0.001);the infection rate of Tibetan population was higher than that of Han population(62.9%,313/498 vs.51.5%,1804/3503),and the difference was statistically significant(χ^(2)=22.56,P<0.001).The H.pylori infection rate in people living at an altitude>3500 m was higher than that of people living at an altitude between 1500 m and 3500 m(61.8%,327/529 vs.52.5%,2204/4195),and the difference was statistically significant(χ^(2)=16.25,P<0.001).Compared with those without corresponding habits,the infection rate of H.pylori was higher in smokers(62.1%,1081/1740 vs.48.6%,1450/2984),in people who had the habit of eating hand grabbed mutton(55.4%,967/1744 vs.52.5%,1564/2980),raw garlic(55.5%,968/1744 vs.52.4%,1563/2980),spicy food(55.6%,1471/2647 vs.51.0%,1060/2077),sweet food(55.2%,1187/2149 vs.52.2%,1344/2575),the infection rate of tea drinkers was lower(50.5%,1135/2247 vs.56.4%,1396/2477),and the differences were statistically significant(χ^(2)=80.94,3.89,9.63,4.36,4.13 and 16.19,all P<0.05).The results of logistic regression analysis indicated that Tibetan(OR=1.379,95%confidence interval(95%CI)1.120 to 1.699),the Hui people(OR=1.362,95%CI 1.117 to 1.662),living at an altitude over 3500 m(OR=1.355,95%CI 1.107 to 1.657),smoking(OR=1.847,95%CI 1.629 to 2.094),and spicy food(OR=1.224,95%CI 1.084 to 1.382)were independent risk factors of H.pylori infection(all P<0.05).Conclusions The infection rate of H.pylori in Qinghai Province is higher than the average level in inland China.The infection rate of people with different ages,nationalities,altitudes of residence,occupations,living and eating habits were different.The infection rate of female over 30 years old is decreasing year by year.The infection risk is high in Hui people and Tibetan,spicy food lovers,smokers and people living at an altitude>3500 m.