社区人群幽门螺杆菌再感染的危险因素及根除诊疗优化方案的构建

Risk Factors for Helicobacter Pylori Reinfection in a Community-based Population and the Construction of An Optimal Treatment Plan for Eradication

目的:探究社区人群幽门螺杆菌再感染的危险因素,并构建根除诊疗优化方案。方法:2022年7—12月按照随机、双盲的方法选取在上海市高行社区卫生服务中心接受治疗的幽门螺杆菌感染阳性患者472例,经过规范化治疗2周后共有116例符合纳入标准的幽门螺杆菌感染阳性转阴患者。按照随机数表法将116例患者分为对照组(58例)和干预组(58例)。不给予对照组患者任何干预,给予干预组患者家庭医生社区干预,干预内容包括饮食、生活习惯、慢性病用药指导与监督等。干预时间为转阴后的6个月。评价患者转阴6个月后幽门螺杆菌再感染情况。结果:干预后,干预组幽门螺杆菌再感染患者2例,幽门螺杆菌根除率为96.55%(56/58);对照组幽门螺杆菌再感染患者27例,幽门螺杆菌根除率为53.45%(31/58)。两组患者幽门螺杆菌根除率比较,差异有统计学意义(χ^(2)=28.736,P<0.05)。对29例幽门螺杆菌再感染患者进行单因素分析,结果显示,直系亲属文化程度、刷牙频率、上消化道疾病史、饮酒史及新鲜水果食用频率对患者幽门螺杆菌再感染的影响,差异有统计学意义(χ^(2)值分别为4.647、7.302、4.296、4.494和6.121,P值均<0.05)。logistic回归分析结果显示,直系亲属文化程度为初中及以下、不刷牙、有上消化道疾病史、有饮酒史及从不食用新鲜水果为幽门螺杆菌再感染的危险因素。结论:四联疗法联合家庭医生团队的社区干预、养成良好的就医行为对于幽门螺杆菌的根除治疗效果更佳。

OBJECTIVE To investigate the risk factors of H.pylori reinfection in the community population,and to construct an optimal plan for eradication treatment and analyze the treatment effect.METHODS From July to December 2022,472 patients with positive helicobacter pylori infection who received treatment in Shanghai Gaohang Community Health Service Center were selected in a randomized,double-blind method.After 2 weeks of standardized treatment,a total of 116 patients with positive helicobacter pylori infection who met the criteria and turned negative were detected.They were divided into control group(58 cases)and intervention group(58 cases)according to random number table method.Patients in the control group were not given any intervention,and family doctors in the intervention group were given community intervention after recovery,including diet,living habits,medication guidance and supervision for chronic diseases.To evaluate the re-infection of helicobacter pylori in the patients within half a year after they turned negative.RESULTS After intervention,there were 2 cases of helicobacter pylori reinfection in the intervention group,and the eradication rate was 96.55%(56/58).In the control group,27 patients were reinfected with Helicobacter pylori,and the eradication rate of helicobacter pylori was 53.45%(31/58).There was significant difference in the eradication rate of Helicobacter pylori between the intervention group and the control group(χ^(2)=28.736,P<0.05).The results showed that the influence of immediate family education,brushing frequency,upper digestive tract disease history,drinking history and fresh fruit consumption frequency on Helicobacter pylori reinfection was significant.The difference was statistically significant(χ^(2)=4.647,7.302,4.296,4.494,6.121,respectively,P<0.05).logistic regression analysis showed that the risk factors of H.pylori reinfection were immediate family members with junior high school education or below,no teeth brushing,history of upper digestive tract disease,drinking history and never eating fresh fruit.CONCLUSION Quadruple therapy combined with the community intervention of family doctor team and the development of good medical behavior are more effective for the eradication of Helicobacter pylori reinfection.