摘要
目的本文从流行病学角度研究西安地区幽门螺杆菌细胞毒素相关蛋白 A(CagA)阳性 Hp 菌株感染与胃十二指肠溃疡发病的关系.方法采用病例对照研究方法,病例组与对照组的配比比例为1:2.病例组为本院消化科自1997-10/1998-10连续住院的患者,经内镜检查及病理检查证实为活动期胃溃疡和(或)十二指肠溃疡.对照组分为两组,对照1组为同期住院的本科及其他科住院的非胃十二指肠疾病患者,对照2组为同期普查健康人群.病例组与对照组的配比因素为性别、民族、年龄(相差5岁以内).采用问卷调查,内容涉及与胃十二指肠溃疡发病可能有关的32个因素,对所有因素进行量化,应用 SAS 软件进行处理.CagA 阳性 Hp 感染的检测结果分析采用 x^2检验.对所调查因素首先进行1:1及1:2单因素条件 Logistic 回归分析,有显著性意义的因素,计算近似相对危险度(odds ratio,OR)及其95%的可信区间(confidence interval,CI).两因素协同作用采用分层分析方法.对单因素分析时作用较大及调查结果较准确的因素,用多因素条件 Logistic 回归分析.血清中抗 CagA 抗体的检测采用斑点金免疫渗滤法(DIGFA).结果①在胃溃疡组与对照1组及对照2组的配对研究中,胃溃疡组的 CagA 阳性 Hp 感染率显著高于两个对照组,OR 分别为5.0与6.5,P 分别<0.05及<0.01.②在十二指肠溃疡组与对照1组及对照2组的配对研究中,十二指肠溃疡组的CagA 阳性 Hp 感染率显著高于两个对照组,OR 分别为9.33与11.00,P 分别<0.05及<0.01.③1:1及1:2单因素及多因素 Logistic 回归分析表明,Caga 阳性 Hp 感染、吸烟、饮酒、食酸辣食物、生活不规律、精神因素等因素与胃十二指肠溃疡发病呈正相关,而按时进餐与胃十二指肠溃疡发病呈负相关.cagA 阳性 Hp 感染与胃溃疡及十二指肠溃疡的发生具有密切的相关性(OR=16.61-84.49).④双因素分层分析中,吸烟、饮酒、生活不规律、精神因素、食酸辣食物等因素与 CagA 阳性Hp 感染之间作用相互独立,但在胃十二指肠溃疡病的发生中具有协同作用.结论消化性溃疡的发生是众多因素共同作用的结果,CagA 阳性 Hp 菌株感染是引起胃溃疡及十二指肠溃疡多因素病因学中一个非常重要的、危险的因素.重视 CagA 阳性 Hp 菌株的研究,对预防和治疗消化性溃疡具有重要的临床意义和社会意义.
AIM To investigate the relationship between gastroduodenal ulcer and infection of Helicobacter pylori (Hp) expressed cytotoxin associated gene A (CagA) and other related factors. METHODS Case group was matched on sex,race and age (within five years) to controls.All cases were patients admitted to the Department of Gastroenterology in Xi'an Central Hospital from October 1997 to October 1998,and were confirmed to be active gastroulcer and duodenal ulcer by gastroscopy and histological examination.There were two control groups,one was of non-gastroeduodenal disease,the other was of healthy population.All subjects complected a complex questionaire containing 32 factors and were examined for Hp-CagA-IgG by dot immunogold filtration assay (DIGFA).The data was analyzed with SAS software. RESULTS In gastric ulcer,CagA positive Hp infection rate was higher than in control groups,OR was 5.0 and 6.5 (P<0.05,P<0.01).In duodenal ulcer,CagA positive Hp infection rate was higher than in control groups,OR was9.3 and 11.0 (P<0.05,P<0.01).The 1:1 and 1:2 simple and multivariate logistic analyses showed that risk factors for gastric ulcer and duodenal ulcer were CagA positive Hp infection,smoking,alcohol-drinking, vinegar-pepper dict,irregular lifestylc and psychological factors while regular dict was protective for gastric ulcer and duodenal ulcer.CagA positive Hp infection was closely correlated with gastric ulcer and duodenal ulcer (OR=16.61-84.49).Stratified analysis showed no interaction between CagA positive Hp infection and smoking,drinking,vinegar-pepper diet,irregular lifestyle and psychological factor. CONCLUSION Peptic ulcer is caused by many factors concordantly,and CagA positive Hp infection was a very important and risk factor.Further study on CagA positive Hp will benefit prevention and treatment of peptic ulcer.
出处
《世界华人消化杂志》
CAS
2000年第7期733-736,共4页
World Chinese Journal of Digestology
关键词
幽门螺杆菌
胃溃疡
十二指肠溃疡
细胞毒素类
Helicobacter pylori
stomach ulcer
duodenal ulcer
cytotoxins
case-control studies
gastroscopy
