幽門(mén)螺桿菌再感染率及其影響因素研究
發(fā)布時(shí)間：2018-07-27 21:02
【摘要】：目的:2015年幽門(mén)螺桿菌(Helicobacter plori,H.pylori)胃炎京都共識(shí)及2016年H.pylori感染管理的馬斯特里赫特V(Maastricht V)共識(shí)均將H.pylori胃炎定義為一種傳染病,其傳播途徑可能為口-口或糞-口傳播。不同國(guó)家和地區(qū)H.pylori再感染率不同,目前國(guó)內(nèi)缺乏大宗病例的報(bào)道,河北地區(qū)尚無(wú)H.pylori再感染率以及其影響因素的研究,本研究旨在探討河北石家莊地區(qū)H.pylori的再感染率及其影響因素,以對(duì)患者進(jìn)行更合理的診治提供有效的參考。方法:1病例選擇病例選擇2010年6月1日至2016年6月1日確認(rèn)H.pylori成功根除后的患者,共350例。其中女性為184例,男性為166例,平均年齡(45.07±12.02)歲。1.1入選標(biāo)準(zhǔn):(1)年齡在18-70歲之間,所有確認(rèn)H.pylori成功根除后的350例患者進(jìn)行快速尿素酶試驗(yàn)(RUT)或13C尿素呼吸試驗(yàn)(13C-UBT)及14C尿素呼吸試驗(yàn)(14C-UBT)。(2)成功根除后按隨訪(fǎng)時(shí)間復(fù)查者;(3)治療結(jié)束后符合下列條件之一即為根治成功:(1)13C-尿素呼氣試驗(yàn)或14C-尿素呼氣試驗(yàn)陰性;(2)在胃竇、胃體兩個(gè)部位取材的快速尿素酶試驗(yàn)檢查均需H.pylori陰性[1]。(4)入組前所有患者對(duì)研究方案知情并簽署知情同意,經(jīng)河北醫(yī)科大學(xué)第三醫(yī)院倫理道德委員會(huì)同意。1.2排除標(biāo)準(zhǔn):(1)心肺肝腎功能?chē)?yán)重?fù)p害。(2)惡性腫瘤。(3)有1次以上H.pylori根除治療或1個(gè)月內(nèi)有抗生素治療史者。(4)有胃大部切除手術(shù)史者。(5)成功根除后未按隨訪(fǎng)時(shí)間復(fù)查者。2方法2.1試驗(yàn)方法:對(duì)納入研究的350例H.pylori成功根除后的患者,根據(jù)隨訪(fǎng)時(shí)間行RUT或13C-UBT及14C-UBT,觀察H.pylori成功根除后1年內(nèi)陽(yáng)性率及1年后H.pylori再感染率的情況,將1年后的患者分為兩組,H.pylori再感染組和持續(xù)保持陰性組,分析影響H.pylori再感染的因素。2.2記錄患者一般資料記錄患者姓名、性別、年齡、吸煙、飲酒、文化程度、家庭住址、家庭月收入、暴露(即與h.pylori感染者密切接觸)情況;成功根除h.pylori后6個(gè)月內(nèi)、6個(gè)月至1年、1年至2年、2年-3年、3年-4年、4年-5年、5年-6年檢測(cè)h.pylori再感染情況。2.3統(tǒng)計(jì)方法:利用spss21.0軟件對(duì)數(shù)據(jù)進(jìn)行分析,計(jì)數(shù)資料以百分率表示,再感染率的比較采用χ2檢驗(yàn),p0.05為差異有統(tǒng)計(jì)學(xué)意義;計(jì)量資料數(shù)據(jù)方差不齊的運(yùn)用非參數(shù)秩和檢驗(yàn),檢驗(yàn)水準(zhǔn)取α=0.05,p0.05為差異有統(tǒng)計(jì)學(xué)意義;影響因素分析采用二元logistic回歸分析,b0,or1為危險(xiǎn)因素,p0.05為差異具有統(tǒng)計(jì)學(xué)意義。結(jié)果:1.1隨訪(fǎng)應(yīng)答率對(duì)納入研究的350例h.pylori成功根除后的患者,一年內(nèi)隨訪(fǎng)中失訪(fǎng)0例,應(yīng)答率為100%;其中共有327例患者持續(xù)保持陰性納入第二年至第六年隨訪(fǎng)研究,第二年隨訪(fǎng)中失訪(fǎng)4例,應(yīng)答率為98.77%;第三年隨訪(fǎng)中累計(jì)失訪(fǎng)10例,應(yīng)答率為96.94%;第四年隨訪(fǎng)中累計(jì)失訪(fǎng)18例,應(yīng)答率為94.49%;第五年隨訪(fǎng)中累計(jì)失訪(fǎng)23例,應(yīng)答率為92.66%;第六年隨訪(fǎng)中累計(jì)失訪(fǎng)28例,應(yīng)答率為91.43%。1.2h.pylori根治后再感染率情況h.pylori根除后的再感染情況如table1及table2所示,隨訪(fǎng)六個(gè)月、六個(gè)月至一年,h.pylori出現(xiàn)陽(yáng)性例數(shù)共23例,其中六個(gè)月內(nèi)350例患者中出現(xiàn)14例陽(yáng)性,六個(gè)月至一年內(nèi)336例患者中出現(xiàn)9例陽(yáng)性,h.pylori累積(年)陽(yáng)性率分別為4.00%、6.68%(2.68%);第二年至第六年h.pylori出現(xiàn)陽(yáng)性例數(shù)共13例,其中第二年出現(xiàn)5例陽(yáng)性,第三年出現(xiàn)3例陽(yáng)性,第四年出現(xiàn)2例陽(yáng)性,第五年出現(xiàn)2例陽(yáng)性,第六年出現(xiàn)1例陽(yáng)性,h.pylori年累計(jì)(年)再感染率分別為1.53%、2.47%(0.94%)、3.12%(0.65%)、3.79%(0.67%)、4.13%(0.34%),經(jīng)卡方檢驗(yàn)p0.05,這5年h.pylori再感染率差別無(wú)統(tǒng)計(jì)學(xué)意義;其中隨訪(fǎng)六個(gè)月、六個(gè)月至第一年的h.pylori再感染率高于第一年以后各年(p0.05)。由此可見(jiàn),h.pylori根除后的人群可再次感染h.pylori,再感染率很低,其h.pylori感染第一年內(nèi)出現(xiàn)陽(yáng)性率高于第一年后各年的再感染率,一年后再感染率維持相對(duì)穩(wěn)定,年再感染率為0.82%。1.3 H.pylori再感染率的影響因素:單因素分析:病例在18~31歲、32~45歲、46~57歲、58~70歲,4個(gè)年齡分層均有分布,年齡分布對(duì)H.pylori再感染率無(wú)統(tǒng)計(jì)學(xué)意義(P=0.383),性別對(duì)H.pylori再感染率無(wú)統(tǒng)計(jì)學(xué)意義(P=0.074),吸煙對(duì)H.pylori再感染率無(wú)統(tǒng)計(jì)學(xué)意義(P=0.718),飲酒對(duì)H.pylori再感染率無(wú)統(tǒng)計(jì)學(xué)意義(P=0.064),教育水平對(duì)H.pylori再感染率無(wú)統(tǒng)計(jì)學(xué)意義(P=0.565),居住地對(duì)H.pylori再感染率無(wú)統(tǒng)計(jì)學(xué)意義(P=0.094),暴露因素對(duì)H.pylori再感染率有統(tǒng)計(jì)學(xué)意義(P=0.001),家庭月收入水平對(duì)H.pylori再感染率有統(tǒng)計(jì)學(xué)意義(P=0.047)(見(jiàn)Table3),其中,13例再感染患者處于暴露因素中占11例(84.7%),家庭月收入水平5000元者10例占(69.2%)。經(jīng)二元Logistic回歸多因素分析分析發(fā)現(xiàn)暴露因素(P=0.004,B=1.701,OR=5.482)、家庭月收入水平為再感染的危險(xiǎn)因素(P=0.033,B=1.369,OR=3.932)(見(jiàn)Table4)。結(jié)論:1 H.pylori根除后存在再次感染的情況,年再感染率較低,為0.83%,5年內(nèi)年再感染率維持相對(duì)穩(wěn)定。2暴露因素、家庭月收入水平低為影響H.pylori再感染的危險(xiǎn)因素。
[Abstract]:Objective: in 2015, the Kyoto consensus of Helicobacter plori (H.pylori) gastritis and the V (Maastricht V) consensus of H.pylori infection in 2016 in Maastricht all defined H.pylori gastritis as an infectious disease, and its transmission route may be oral mouth or fecal oral transmission. The rate of H.pylori reinfection in different countries and regions is different, and the present country is present. In the lack of large cases, there is no study on the reinfection rate of H.pylori and its influencing factors in Hebei area. This study aims to explore the reinfection rate and its influencing factors of H.pylori in Shijiazhuang region of Hebei, so as to provide effective reference for more reasonable diagnosis and treatment for patients. Methods: 1 cases selected cases were selected from June 1, 2010 to 2016. In June 1st, 350 patients were confirmed by H.pylori successfully eradicated, of which 184 cases were female, 166 cases were male, the average age (45.07 + 12.02) years old.1.1 standard: (1) between 18-70 years old, all the 350 patients who confirmed the successful eradication of H.pylori were fast urea enzyme test (RUT) or 13C urea breath test (13C-UBT) and 14C urea call (14C-UBT). (2) after successful eradication, the patients were rechecked according to the follow-up time; (3) after the end of the treatment, one of the following conditions was a radical cure: (1) 13C- urea breath test or 14C- urea breath test negative; (2) the rapid urease test in the gastric antrum and the two parts of the stomach body needed all H.pylori negative [1]. (4) in all patients before the group. The study plan informed and signed informed consent, the ethics committee of the Third Hospital of Hebei Medical University agreed with the.1.2 exclusion criteria: (1) serious impairment of heart and lung function and kidney function. (2) malignant tumor. (3) there are more than 1 times of H.pylori eradication treatment or 1 months of antibiotic treatment. (4) there is a history of large partial gastrectomy. (5) after successful eradication .2 method 2.1 test of follow-up time reexamination: 350 cases of successful eradication of H.pylori in the study were performed by RUT or 13C-UBT and 14C-UBT according to the follow-up time. The positive rate within 1 years after the successful eradication of H.pylori and the rate of H.pylori reinfection after 1 years were observed, and the patients after 1 years were divided into two groups, H.pylori reinfection group and continuous maintenance. Negative group, analysis of factors affecting H.pylori reinfection.2.2 record patient's name, sex, age, smoking, drinking, education, family address, family monthly income, exposure (that is, close contact with H.pylori infected persons); successfully eradicated H.pylori within 6 months, from 6 months to 1 years, 1 to 2 years, 2 years -3, 3 year -4, 4 -5 year, -5 year, -6 year of 5 years to detect the reinfection status of.2.3 statistical methods: using spss21.0 software to analyze the data, the count data are expressed as a percentage, the re infection rate is compared with the x 2 test, P0.05 is statistically significant; the measurement data variance is not homogeneous in the non parametric rank sum test, the test level takes the alpha =0.05, P0.05 as The difference was statistically significant; the analysis of influencing factors adopted two yuan logistic regression analysis, B0, or1 as a risk factor, and P0.05 was statistically significant. Results: 1.1 follow-up response rate to 350 cases of successful eradication of H.pylori in the study, 0 cases were lost in one year follow-up, the response rate was 100%; of which 327 patients continued to maintain. The negative included second to sixth year follow-up studies. 4 cases were lost in second years of follow-up, and the response rate was 98.77%. 10 cases were lost in third year follow-up, the response rate was 96.94%; 18 cases were lost in the fourth year follow-up and the response rate was 94.49%. The response rate was 91.43%.1.2h.pylori after radical reinfection rate of reinfection rate of H.pylori after radical reinfection, such as table1 and table2, followed up for six months, six months to one year, 23 cases of positive cases appeared in H.pylori, of which 14 cases were positive in 350 cases within six months, 9 in 336 patients from six months to one year, and H.pylori was tired. The positive rate of product (year) was 4%, 6.68% (2.68%), and 13 cases were positive in H.pylori from second to sixth years, of which 5 cases were positive in second years, 3 cases were positive in third years, 2 positive in fourth, positive in fifth years. 3.12% (0.65%), 3.79% (0.67%), 4.13% (0.34%). There was no statistically significant difference in the rate of reinfection of H.pylori for 5 years by chi square test P0.05. The rate of H.pylori reinfection for six months, six months to the first year was higher than the year after the first year (P0.05). Thus, the population after H.pylori eradication could be re infected with H.pylori, and the rate of reinfection was very low, its H The positive rate of.Pylori infection in the first year was higher than that of the year after the first year. The reinfection rate remained relatively stable one year later and the rate of reinfection was 0.82%.1.3 H.pylori reinfection rate: a single factor analysis: the case was at the age of 18~31, 32~45, 46~57, 58~70, and the 4 age stratification was distributed, and the age distribution of H.pylori The reinfection rate was not statistically significant (P=0.383), the reinfection rate of H.pylori was not statistically significant (P=0.074), and there was no statistical significance for the reinfection rate of H.pylori (P=0.718). There was no statistical significance (P=0.064) for the reinfection rate of H.pylori (P=0.064), and the education level had no statistical significance for the reinfection rate of H.pylori (P=0.565), and the residence of the reinfection rate of H.pylori again. The infection rate was not statistically significant (P=0.094), and the exposure factor had statistical significance to the reinfection rate of H.pylori (P=0.001), and the monthly income level of the family had statistical significance to the reinfection rate of H.pylori (P=0.047) (Table3), of which 13 cases of reinfection were in exposure factors (84.7%), and 10 cases (69.2%) of the family monthly income level 5000 yuan (69.2%). Two yuan Logistic regression analysis and analysis found exposure factors (P=0.004, B=1.701, OR=5.482) and family monthly income level as a risk factor for reinfection (P=0.033, B=1.369, OR=3.932) (Table4). Conclusion: there is a recurrence of re infection after 1 H.pylori eradication. The annual reinfection rate is low, 0.83%, and the annual reinfection rate in 5 years maintains a relatively stable.2. Exposure factors and low monthly household income level were risk factors for H.pylori re infection.
【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R573.3
本文編號(hào)：2149127
[Abstract]:Objective: in 2015, the Kyoto consensus of Helicobacter plori (H.pylori) gastritis and the V (Maastricht V) consensus of H.pylori infection in 2016 in Maastricht all defined H.pylori gastritis as an infectious disease, and its transmission route may be oral mouth or fecal oral transmission. The rate of H.pylori reinfection in different countries and regions is different, and the present country is present. In the lack of large cases, there is no study on the reinfection rate of H.pylori and its influencing factors in Hebei area. This study aims to explore the reinfection rate and its influencing factors of H.pylori in Shijiazhuang region of Hebei, so as to provide effective reference for more reasonable diagnosis and treatment for patients. Methods: 1 cases selected cases were selected from June 1, 2010 to 2016. In June 1st, 350 patients were confirmed by H.pylori successfully eradicated, of which 184 cases were female, 166 cases were male, the average age (45.07 + 12.02) years old.1.1 standard: (1) between 18-70 years old, all the 350 patients who confirmed the successful eradication of H.pylori were fast urea enzyme test (RUT) or 13C urea breath test (13C-UBT) and 14C urea call (14C-UBT). (2) after successful eradication, the patients were rechecked according to the follow-up time; (3) after the end of the treatment, one of the following conditions was a radical cure: (1) 13C- urea breath test or 14C- urea breath test negative; (2) the rapid urease test in the gastric antrum and the two parts of the stomach body needed all H.pylori negative [1]. (4) in all patients before the group. The study plan informed and signed informed consent, the ethics committee of the Third Hospital of Hebei Medical University agreed with the.1.2 exclusion criteria: (1) serious impairment of heart and lung function and kidney function. (2) malignant tumor. (3) there are more than 1 times of H.pylori eradication treatment or 1 months of antibiotic treatment. (4) there is a history of large partial gastrectomy. (5) after successful eradication .2 method 2.1 test of follow-up time reexamination: 350 cases of successful eradication of H.pylori in the study were performed by RUT or 13C-UBT and 14C-UBT according to the follow-up time. The positive rate within 1 years after the successful eradication of H.pylori and the rate of H.pylori reinfection after 1 years were observed, and the patients after 1 years were divided into two groups, H.pylori reinfection group and continuous maintenance. Negative group, analysis of factors affecting H.pylori reinfection.2.2 record patient's name, sex, age, smoking, drinking, education, family address, family monthly income, exposure (that is, close contact with H.pylori infected persons); successfully eradicated H.pylori within 6 months, from 6 months to 1 years, 1 to 2 years, 2 years -3, 3 year -4, 4 -5 year, -5 year, -6 year of 5 years to detect the reinfection status of.2.3 statistical methods: using spss21.0 software to analyze the data, the count data are expressed as a percentage, the re infection rate is compared with the x 2 test, P0.05 is statistically significant; the measurement data variance is not homogeneous in the non parametric rank sum test, the test level takes the alpha =0.05, P0.05 as The difference was statistically significant; the analysis of influencing factors adopted two yuan logistic regression analysis, B0, or1 as a risk factor, and P0.05 was statistically significant. Results: 1.1 follow-up response rate to 350 cases of successful eradication of H.pylori in the study, 0 cases were lost in one year follow-up, the response rate was 100%; of which 327 patients continued to maintain. The negative included second to sixth year follow-up studies. 4 cases were lost in second years of follow-up, and the response rate was 98.77%. 10 cases were lost in third year follow-up, the response rate was 96.94%; 18 cases were lost in the fourth year follow-up and the response rate was 94.49%. The response rate was 91.43%.1.2h.pylori after radical reinfection rate of reinfection rate of H.pylori after radical reinfection, such as table1 and table2, followed up for six months, six months to one year, 23 cases of positive cases appeared in H.pylori, of which 14 cases were positive in 350 cases within six months, 9 in 336 patients from six months to one year, and H.pylori was tired. The positive rate of product (year) was 4%, 6.68% (2.68%), and 13 cases were positive in H.pylori from second to sixth years, of which 5 cases were positive in second years, 3 cases were positive in third years, 2 positive in fourth, positive in fifth years. 3.12% (0.65%), 3.79% (0.67%), 4.13% (0.34%). There was no statistically significant difference in the rate of reinfection of H.pylori for 5 years by chi square test P0.05. The rate of H.pylori reinfection for six months, six months to the first year was higher than the year after the first year (P0.05). Thus, the population after H.pylori eradication could be re infected with H.pylori, and the rate of reinfection was very low, its H The positive rate of.Pylori infection in the first year was higher than that of the year after the first year. The reinfection rate remained relatively stable one year later and the rate of reinfection was 0.82%.1.3 H.pylori reinfection rate: a single factor analysis: the case was at the age of 18~31, 32~45, 46~57, 58~70, and the 4 age stratification was distributed, and the age distribution of H.pylori The reinfection rate was not statistically significant (P=0.383), the reinfection rate of H.pylori was not statistically significant (P=0.074), and there was no statistical significance for the reinfection rate of H.pylori (P=0.718). There was no statistical significance (P=0.064) for the reinfection rate of H.pylori (P=0.064), and the education level had no statistical significance for the reinfection rate of H.pylori (P=0.565), and the residence of the reinfection rate of H.pylori again. The infection rate was not statistically significant (P=0.094), and the exposure factor had statistical significance to the reinfection rate of H.pylori (P=0.001), and the monthly income level of the family had statistical significance to the reinfection rate of H.pylori (P=0.047) (Table3), of which 13 cases of reinfection were in exposure factors (84.7%), and 10 cases (69.2%) of the family monthly income level 5000 yuan (69.2%). Two yuan Logistic regression analysis and analysis found exposure factors (P=0.004, B=1.701, OR=5.482) and family monthly income level as a risk factor for reinfection (P=0.033, B=1.369, OR=3.932) (Table4). Conclusion: there is a recurrence of re infection after 1 H.pylori eradication. The annual reinfection rate is low, 0.83%, and the annual reinfection rate in 5 years maintains a relatively stable.2. Exposure factors and low monthly household income level were risk factors for H.pylori re infection.
【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R573.3
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