老年人长期服用阿司匹林与幽门螺杆菌感染的相关性及对根除疗效的影响

Correlation between long-term use of aspirin and Helicobacter pylori infection in elderly people and its effectiveness on Helicobacter pylori eradication

目的探讨老年人长期服用小剂量阿司匹林与幽门螺杆菌(HP)感染的相关性以及对HP根除疗效和复发的影响。方法回顾性分析,选取2010年3月至2019年12月兰州大学第一医院体检中心首次行C13-或C14-尿素呼气试验检测(UBT)的60岁及以上老年人2834例,按UBT检测结果分为HP感染组1510例、HP未感染组1324例。采用单因素及多因素Logistic回归分析方法探讨服用阿司匹林与感染HP之间的关系。同时行前瞻性病例对照分析,选取2015年3月至2020年12月诊断为HP感染的老年高血压患者544例,根据是否服用阿司匹林分为服药组(402例)和观察组(142例),服药组根据服用阿司匹林疗程再次分为1~<2年组(134例)、≥2~<5年组(142例)和≥5年组(126例),比较给予含铋剂四联疗法根除HP的疗效、安全性及1年后复发情况。结果HP总体感染率为53.28%(1510/2834)。单因素分析结果显示,女性的感染率较男性高[56.86%(584/1027)比51.25%(926/1807),χ^(2)=8.307、P=0.004]、服用阿司匹林感染率较未服用阿司匹林者高[57.29%(920/1606)比48.05%(590/1228),χ^(2)=23.866、P<0.001]、服用阿司匹林1~<2年、≥2~<5年和≥5年组的感染率差异则无统计学意义[60.22%(162/269)比56.40%(273/484)比56.86%(485/853),χ^(2)=1.166、P=0.558];HP感染组的空腹血糖较HP未感染组高[(5.92±1.78)mmol/L比(5.77±1.40)mmol/L,t=2.317、P=0.021]。多因素Logistic回归分析结果显示,女性感染HP风险高于男性(OR=1.254、95%CI:1.075~1.464、P=0.004),长期服用阿司匹林增加HP感染风险(OR=1.450、95%CI:1.249~1.684、P<0.001)。入选根除治疗的544例中最终完成治疗例数522例,成功根除例数479例,总体根除率按方案分析为91.76%(479/522),按意向治疗分析为88.05%(479/544)。1年后完成复查例数472例,总体复发率为3.6%(17/472)。不同时间服药组和观察组患者的根除率、复发率比较差异均无统计学意义(均P>0.05)。结论长期服用小剂量阿司匹林增加老年人感染HP的风险,但并不影响铋剂四联疗法的根除率和1年复发率,应定期行HP检测并予以根除。

Objective To investigate the correlation between long-term use of low-dose aspirin and Helicobacter pylori(HP)infection in elderly people and its effectiveness on HP eradication and recurrence.Methods A retrospective analysis was conducted on 2834 elderly people aged 60 and above who underwent the C13-or C14-urea breath test(UBT)for the first time in the Physical Examination Center of the First Hospital of Lanzhou University between March 2010 and December 2019.According to the results of UBT,people were divided into an HP infection group with 1510 patients and a non-HP infection group with 1324 patients.Univariate and multivariate Logistic regression analysis were used to investigate the relationship between aspirin use and HP infection.Additionally,in a prospective case-control analysis,544 elderly hypertensive patients diagnosed with HP infection between March 2015 and December 2020 were selected and divided into an aspirin group(402 cases)and an observation group(142 cases),based on whether aspirin was used.The aspirin group was further divided into a 1 to<2 years group(134 cases),a≥2 to<5 years group(142 cases)and a≥5 years group(126 cases)based on the duration of aspirin treatment.The rates of HP eradication,safety and one-year post-treatment HP recurrence with bismuth-containing quadruple therapy were compared.Results The overall HP infection rate was 53.28%(1510/2834).Univariate analysis showed that the infection rate in women was higher than in men[56.86%(584/1027)vs.51.25%(926/1807),χ^(2)=8.307,P=0.004].The infection rate in aspirin users was higher than in non-aspirin users[57.29%(920/1606)vs.48.05%(590/1228),χ^(2)=23.866,P<0.001],with no significant difference between aspirin use for 1-<2 years,≥2-<5 years and≥5 years[60.22%(162/269)vs.56.4%(273/484)vs.56.86%(485/853),χ^(2)=1.166,P=0.558].Fasting blood glucose levels in the HP infection group were higher than in the non-HP infection group[(5.92±1.78)mmol/L vs.(5.77±1.40)mmol/L,t=2.317,P=0.021].Multivariate Logistic regression analysis showed the risk of HP infection in women was higher than in men(OR=1.254,95%CI:1.075-1.464,P=0.004).Long-term aspirin use increased the risk of HP infection(OR=1.450,95%CI:1.249-1.684,P<0.001).Among the 544 cases selected for eradication therapy,522 completed the treatment protocol,with 479 achieving successful eradication.The overall eradication rate was 91.76%(479/522)according to per-protocol(PP)analysis and 88.05%(479/544)according to intention-to-treat(ITT).After 1 year,472 cases underwent reexamination,with an overall recurrence rate of 3.6%(17/472).There was no statistical significance in the eradication rate and recurrence rate among the groups with different durations of aspirin treatment and the observation group.Conclusions Long-term use of low-dose aspirin increases the risk of HP infection in the elderly,but does not affect the eradication rate and one-year recurrence rate of bismuth-containing quadruple therapy.Therefore,periodic screening and eradication of HP should be performed.