儿童幽门螺杆菌感染的影响因素分析

Analysis of the influencing factors of helicobacter pylori infection in children

目的:探索3至14岁儿童幽门螺杆菌(HP)感染的影响因素,为儿童HP感染的防治提供临床依据。方法:随机选取2021年9月至2023年6月因体检和(或)反复消化道不适、恶心、呕吐、打嗝、嗳气等症状来徐州医科大学附属医院儿科就诊的720例3至14岁儿童为研究对象,通过^(13)C尿素呼气试验(^(13)C-UBT)检查其HP感染情况,通过线上问卷收集儿童的一般情况、生活方式、家族史等情况。结果:720例患儿中,有308例HP感染阳性,总阳性率为42.78%。3~6、7~11、12~14岁组的HP感染率分别为15.2%、43.3%、69.5%。不同性别的儿童HP感染率比较,差异无统计学意义(P>0.05)。多因素分析结果显示:7~11岁(OR=12.457,95%CI 2.720~57.044,P=0.001)及12~14岁(OR=5.926,95%CI 2.009~14.476,P=0.001)、人均居住面积<30 m^(2)(OR=8.082,95%CI 2.507~26.056,P<0.001)、喜食路边食品(OR=3.373,95%CI 1.342~8.475,P=0.010)、家庭养宠物(OR=3.230,95%CI 1.281~8.143,P=0.013)、家庭成员有胃病史(OR=2.787,95%CI 1.087~7.150,P=0.033)、家庭成员有HP感染史(OR=2.699,95%CI 1.375~5.298,P=0.004)、儿童有消化道症状(OR=30.598,95%CI 12.370~75.688,P<0.001)、食用酸奶的频率每周<4次(OR=24.127,95%CI 5.466~106.497,P<0.001)、母亲学历低(OR=7.774,95%CI 1.347~44.855,P=0.022)等为患儿HP感染的危险因素,居住在农村(OR=0.267,95%CI 0.083~0.863,P=0.027)、饭前便后洗手(OR=0.245,95%CI 0.065~0.923,P=0.038)为保护因素。结论:年龄较大、人均居住面积小、喜食路边食品、食用酸奶的频率低、家庭养宠物、母亲学历低、家庭成员有胃病或HP感染病史等是儿童HP感染的危险因素,而居住在农村和饭前便后洗手是保护因素。通过引导儿童培养良好的卫生饮食习惯,避免亲密接触宠物及接触宠物后注意洗手,实施家庭分餐制度或使用公筷等措施,对于预防儿童HP感染具有重要意义。

Objective:To investigate the factors influencing Helicobacter pylori(HP)infection among children aged 3 to 14 years,with the goal of providing a clinical foundation for the prevention and treatment of HP infection in children.Methods:From September 2021 to June 2023,we randomly selected 720 children aged 3 to 14 years who presented at the pediatrics department of Xuzhou Medical University Affiliated Hospital for either routine physical examinations or recurrent gastrointestinal discomfort,including symptoms such as nausea,vomiting,hiccups,and belching.We assessed their HP infection status using the Carbon 13 Urea Breath Test(^(13)C-UBT).In addition to this,we collected general information,lifestyle data,and family histories of the children through online questionnaires.Results:Among the 720 patients studied,308 tested positive for HP infection,resulting in an overall positive rate of 42.78%.The HP infection rates of 3-6,7-11,12-14 years groupwere 15.2%,43.3% and 69.5%,respectively.There was no statistically significant difference in HP infection rates between different genders(P>0.05).Multifactor analysis revealed that several factors were associated with increased risk of HP infection in children,including being in 7-11 years group(OR=12.457,95%CI 2.720-57.044,P=0.001),being in the 12-14 years group(OR=5.926,95%CI 2.009-14.476,P=0.001),per capita living area below 30 m^(2)(OR=8.082,95%CI 2.507-26.056,P<0.001),preference for street food(OR=3.373,95%CI 1.342-8.475,P=0.010),having pets at home(OR=3.230,95%CI 1.281-8.143,P=0.013),family history of stomach disease(OR=2.787,95%CI 1.087-7.150,P=0.033),family history of HP infection(OR=2.699,95%CI 1.375-5.298,P=0.004),presence of gastrointestinal symptoms in children(OR=30.598,95%CI 12.370-75.688,P<0.001),lower frequent consumption of yogurt(OR=24.127,95%CI 5.466-106.497,P<0.001),and lower maternal education(OR=7.774,95%CI 1.347-44.855,P=0.022).Conversely,living in rural areas(OR=0.267,95%CI 0.083-0.863,P=0.027)and regular handwashing before meals and after defecation(OR=0.245,95%CI 0.065-0.923,P=0.038)were identified as protective factors against HP infection.Conclusion:This study highlights several risk factors for HP infection in children,including older age,smaller per capita living area,preference for street food,lower frequent yogurt consumption,the presence of pets at home,lower maternal education,and a family history of stomach disease or HP infection.Conversely,living in rural areas and regular handwashing before meals and after defecation were protective factors.Encouraging children to develop good hygiene and dietary habits,promoting proper pet care practices,implementing separate family meals or using public utensils,and emphasizing the importance of handwashing can significantly contribute to the prevention of HP infection in children.