肝硬化与幽门螺杆菌关系的临床研究

A Clinical Study on Relationship between Liver Cirrhosis and Helicobacter pylori

目的 :研究肝硬化患者幽门螺杆菌 (HP)感染情况及影响因素。方法 :随机选取确诊的肝硬化患者6 0例行上消化道内镜检查 ,通过快速尿素酶试验 (RUT)、Warthin Starry银染色及抗HP IgG的测定来判断HP感染 ,并进行统计学分析。结果 :(1)肝硬化患者HP感染率为 6 6 6 7% ,高于同期检查的非溃疡性消化不良 (NUD)患者HP感染率 (4 1 6 7% ,P <0 0 5 ) ,但低于慢性胃炎患者 (82 5 % ,P <0 0 5 )。 (2 )HP感染率随食管静脉曲张程度的增加而下降 (无食管静脉曲张者HP阳性率为 87 5 % ,有食管静脉曲张者HP阳性率为 5 9 0 9% ,P <0 0 5 ;轻度食管静脉曲张者HP阳性率为 71 4 3% ,中重度食管静脉曲张者HP阳性率为 37 5 % ,P <0 0 5 )。 (3)HP感染与肝硬化患者肝功能分级无关。结论 :(1)肝硬化患者有较高的HP感染率 ;(2 )HP感染与肝硬化门脉高压有关 ,与患者肝功能分级无关。

Objective: To investigate the prevalence of Helicobacter pylori infection in patients with liver cirrhosis (LC) and influence factors. Methods: 60 patients with cirrhosis admitted or seen as outpatients were randomly chosen into this study. The diagnosis of cirrhosis in each patient was confirmed by a combination of clinical, biochemical, imaging and endoscopic methods. The severity of cirrhosis was assessed by Pugh’s modification of Child’s criteria. Upper gastrointestinal endoscopy was assessed by histology, urease test, and serology. Among the patients, there were 50 males and 10 females with a mean (SD) age of 42.3 (10.3) years; 39 Child A and 21 Child B; 56 hepatitic cirrhosis and 4 alcoholic cirrhosis, 40 H. pylori-positive and 20 H. pylori-negative. Results: 1) H. pylori prevalence in patients with liver cirrhosis was 66.6%, which was significantly higher than that in patients with non-ulcer dyspepsia (NUD) (41.67%, P<0.05) but lower than that in patients with chronic gastritis (CG) (82.5%, P<0.05). 2) The prevalence of H. pylori decreased as esophageal varices aggravated. 3) There was no significant relationship between H. pylori infection and Child’s classification. Conclusion: 1) There is a higher prevalence of H. pylori in patients with liver cirrhosis; 2) there is a significant relationship between H. pylori infection and portal hypertension; 3)the association between H. pylori infection and Child’s classification is weak in cirrhosis.