基于自然人群的反流性食管炎与幽门螺杆菌感染相关性研究

The correlation between reflux esophagitis and Helicobacter pylori infection based on natural population

目的反流性食管炎(RE)可能与幽门螺杆菌(H.pylori)感染负相关,但结论及相关机制尚存争议。本研究拟基于自然人群探讨RE与H.pylori感染的相关性。方法2013年7月至2014年12月,于山东省临朐县、河南省滑县采取整体抽样法连续纳入3940名40~69岁常住居民,所有受试者行胃镜检查,留取胃黏膜活检标本行病理诊断及Warthin-Starry(WS)染色明确H.pylori感染状态,部分受试者留取静脉血行H.pylori免疫球蛋白G(H.pylori-IgG)检测,并收集人口社会学资料。采用χ^(2)检验及logistic回归分析RE与H.pylori感染的相关性。结果共检出359例RE,除外RE及其他上消化道器质性疾病的3382名设为对照组,χ^(2)检验示RE组WS阳性率显著低于对照组(P=0.023),但H.pylori-IgG阳性率在两组间差异无统计学意义(P=0.281)。RE组与对照组在性别构成、年龄、体重指数(BMI)、吸烟、饮酒、受教育程度及黏膜活动性炎症方面差异有统计学意义。多因素回归分析示RE的发生与胃黏膜活动性炎症呈负相关[OR=0.754(95%CI 0.600~0.949),P=0.016],与男性[OR=4.231(95%CI 3.263~5.486),P<0.001]、年龄≥60岁、BMI≥24 kg/m^(2)[OR=1.540(95%CI 1.220~1.945),P<0.001]呈正相关,年龄≥60岁者相对于40~49岁者、50~59岁者发生RE的OR=1.566(95%CI 1.144~2.143)(P=0.005)、OR=1.405(95%CI 1.093~1.805)(P=0.008)。结论RE与H.pylori现症感染关系更密切,多因素分析示RE与H.pylori感染导致胃黏膜的活动性炎症呈负相关,与男性、超重及年龄≥60岁呈正相关。

Objective Reflux esophagitis(RE)may be negatively correlated with Helicobacter pylori(H.pylori)infection,but the conclusion and relevant mechanism is still controversial.This study proposed to explore the correlation between RE and H.pylori infection based on natural population.Methods From July 2013 to December 2014,3940 residents aged 40-69 years were recruited in Linqu County of Shandong Province and Hua County of Henan Province by the whole sampling method.All the subjects underwent gastroscopy,and gastric mucosa biopsy specimens were collected for pathological diagnosis and Warthin-Starry(WS)staining to identify H.pylori infection.Venous blood samples of some subjects were collected for H.pylori immunoglobulin G(H.pylori-IgG)detection.Also,demographic and sociological data were collected.Chi-square test and logistic regression were used to analyze the correlation between RE and H.pylori infection.Results A total of 359 cases of RE were detected.Excluding RE and other upper gastrointestinal organic diseases,3382 cases were considered as controls.Chi-square test showed that WS staining positive rate in RE group was significantly lower than that in control group(P=0.023),but there was no significant difference in the positive rate of H.pylori-IgG between the two groups(P=0.281).There were significant differences between RE group and control group in gender composition,age,body mass index(BMI),smoking,alcohol consumption,education level and mucosal active inflammation.Multivariate regression analysis showed that RE was negatively correlated with gastric mucosa active inflammation[OR=0.754(95%CI 0.600-0.949),P=0.016],and positively correlated with male[OR=4.231(95%CI 3.263-5.486),P<0.001],age≥60 years,BMI≥24 kg/m^(2)[OR=1.540(95%CI 1.220-1.945),P<0.001].Compared to those aged 40-49 years and 50-59 years,the odds ratio(OR)of RE in these aged≥60 years were 1.566(95%CI 1.144-2.143,P=0.005)and 1.405(95%CI 1.093-1.805,P=0.008).Conclusion RE is more closely related to H.pylori present infection.Multivariate analysis showed that RE is negatively correlated with active inflammation of gastric mucosa caused by H.pylori infection,and positively correlated with male,overweight and aged≥60 years.