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幽门螺杆菌感染与HBV相关肝硬化常见死亡原因的关系
Effects of Helicobacter pylori infection on common lethal factors for hepatitis B virus-related cirrhosis
文章发布日期:2015年08月11日  来源:  作者:李钰伶,单正飞,石磊,等  点击次数:1502次  下载次数:283次

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【摘要】:目的探讨幽门螺杆菌(H. pylori)感染与HBV相关肝硬化(HBC)常见致死因素的关系。方法回顾性分析2008年10月-2014年10月于大连医科大学附属第一医院及烟台毓璜顶医院就诊的235例HBC患者的临床资料,统计H. pylori的感染率;比较其中155例伴有食管和(或)胃底静脉曲张患者H. pylori的感染率;比较其中97例伴有门静脉高压性胃病(PHG)患者H. pylori的感染率;比较其中32例血氨检测的患者H. pylori阳性与阴性组静脉血氨水平。计量资料组间比较采用t检验和方差分析,计数资料组间比较采用χ2检验。结果235例HBC患者的H. pylori阳性率为80.85%(190/235);伴有食管和(或)胃底静脉曲张的患者,胃镜下见食管的曲张静脉呈蛇形迂曲隆起或串珠状改变,胃底的曲张静脉呈孤立瘤样改变,伴或不伴有胃黏膜糜烂,其中轻度、中度、重度曲张者H. pylori阳性率分别为50.55%(46/91)、43.59%(17/39)和76.00%(19/25),差异具有统计学意义(χ2=6.913,P<0.05);伴有PHG的患者,胃镜可见胃黏膜呈蛇皮样改变,可伴有樱桃红斑、猩红疹及糜烂出血表现,其中轻度及重度PHG患者H. pylori阳性率分别为43.33%(26/60)和67.57%(25/37),差异具有统计学意义(χ2=5.391,P<0.05);检测血氨的患者H. pylori阳性组血氨平均浓度[(62.76±13.43) μmol/L]明显高于阴性组[(47.20±12.51) μmol/L],差异具有统计学意义(t=3.39,P<0.01)。结论HBC患者中H. pylori的感染率高,且H. pylori感染很可能增加食管和(或)胃底静脉曲张以及PHG的严重程度以及升高血氨水平,进而有增加肝硬化主要致死因素上消化道出血及肝性脑病发生风险的可能性。
【Abstract】:Objective To study the relationship between Helicobacter pylori (H. pylori) infection and common lethal factors for hepatitis B virus-related cirrhosis (HBC). Methods A total of 235 patients with HBC who were admitted to our hospitals from October 2008 to October 2014 were retrospectively analyzed. The infection rate of H. pylori in those patients was calculated. In the 155 patients with esophagogastric varices and 97 patients with portal hypertensive gastropathy (PHG), the infection rate of H. pylori was compared between those with different degrees of esophagogastric varices or PHG. In the 32 patients whose blood ammonia was determined, the level of blood ammonia was compared between H. pylori-positive and -negative groups. Between-group comparison of continuous data was performed by t test and analysis of variance, and between-group comparison of categorical data was performed by χ2 test. Results The infection rate of H. pylori in the 235 patients with HBC was 80.85% (190/235). In the 155 patients with esophagogastric varices, who had tortuous serpentine uplift or bead-like changes of esophageal varices and tumor-like changes (with or without gastric erosion) of gastric varices visible under endoscopy, there was significant difference in infection rate of H. pylori between patients with mild, moderate, and severe varices (50.55% (46/91) vs 43.59% (17/39) vs 76% (19/25), χ2=6.913, P<0.05). In the 97 patients with PHG, who had snake skin-like changes, cherry red spots, scarlet rash, and erosion bleeding of gastric mucosa visible under endoscopy, there was significant difference in infection rate of H. pylori between patients with mild and severe PHG (43.33% (26/60) vs 67.57% (25/37), χ2=5.391, P<0.05).In patients whose blood ammonia was determined, patients in H. pylori-positive group had a significantly higher average concentration of blood ammonia than those in H. pylori-negative group (62.76±13.43 vs 47.20±12.51 μmol/L, t= 3.39, P<0.01). Conclusion The infection rateof H. pylori is high in patients with HBC. The H. pylori infection is likely to increase the severity of esophagogastric varices and PHG, as well as the blood ammonia level, which further increases the risk of upper gastrointestinal bleeding and hepatic encephalopathy that are the main lethal factors for HBC.
【关键字】:肝硬化;肝炎,乙型;螺杆菌,幽门;食管和胃静脉曲张;门静脉高压性胃病;肝性脑病
【Key words】:liver cirrhosis; hepatitis B; helicobacter pylori; esophageal and gastric varices; portal hypertensive gastropathy; hepatic encephalopathy
【引证本文】:李钰伶, 单正飞, 石磊, 等. 幽门螺杆菌感染与HBV相关肝硬化常见死亡原因的关系[J]. 临床肝胆病杂志, 2015, 31(9): 1439-1443.

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