HbA1c水平对2型糖尿病患者Hp根除治疗预后的预测价值

发布时间：2018-09-18 13:17

【摘要】：背景与目的:幽门螺杆菌(Hp)与消化系统外疾病的相关性是近年来热议的话题,其中2型糖尿病是Hp感染的危险因素等观点被越来越多的人接受。在糖尿病患者中,并发各种感染的几率较常人增高,这也使得糖尿病患者的既往抗生素使用率增高,随之带来的细菌抗生素耐药机会也大幅度增加,最终会导致Hp根除失败的几率增加,同时血糖控制不佳的患者也伴随着更多的并发症和较差的疾病预后。对于这部分特殊人群的Hp根除管理,有必要制定相关指标以指导有效的抗生素根除治疗,从而避免一些不必要的治疗失败,这或许对延缓细菌耐药的产生等方面做出贡献。本研究意旨研究2型糖尿病患者长期血糖波动情况是否会预测Hp根除的预后,目的在于讨论分析2型糖尿病患者糖化血红蛋白(Hb A1c)水平对其Hp根除预后的预测价值。方法:采用前瞻性研究,收入2016年6月-2017年5月吉林大学第一医院2型糖尿病同时感染Hp患者。进行血浆或指尖血测定Hb A1c值及碳14呼气实验测定Hp感染情况。随后所有患者统一采用相同的含铋剂四联疗法进行Hp根除治疗,治疗结束至少满28天后进行碳14呼气实验复查根除情况。结果:本研究共收入45例患者,男25名、女20名;治疗成功28人,治疗失败17人。单因素分析性别与年龄均无显著统计学意义,Hb A1c水平有显著统计学意义(P0.001),多因素回归分析显示性别与年龄均无显著统计学意义,Hb A1c水平有显著统计学意义(P=0.003,OR=4.730),根据最大约登指数对应得出最佳阳性预测值(cut-off值)分别为Hb A1c=8.5500、预测指数=0.3548。结论:1.2型糖尿病患者长期血糖波动情况是Hp根除预后的影响因素。2.高Hb A1c水平是2型糖尿病患者Hp根除失败的危险因素。3.若2型糖尿病患者Hb A1c水平"g8.55或预测指数"g0.36,提示根除失败风险大,短期内不建议进行根除治疗。
[Abstract]:Background & objective: the relationship between Helicobacter pylori (Hp) and diseases outside the digestive system is a hot topic in recent years. Type 2 diabetes mellitus is a risk factor for Hp infection and has been accepted by more and more people. In patients with diabetes, the risk of various infections is higher than that of the average person, which also increases the use of previous antibiotics in patients with diabetes, and increases the chances of bacterial antibiotic resistance. Ultimately, the chances of failure in Hp eradication are increased, and patients with poor blood glucose control are accompanied by more complications and poor prognosis. For the Hp eradication management of this special population, it is necessary to formulate relevant indicators to guide the effective antibiotic eradication therapy, so as to avoid some unnecessary failure of treatment, which may contribute to delaying the production of bacterial drug resistance and so on. The purpose of this study was to investigate whether long-term blood glucose fluctuations in type 2 diabetes can predict the prognosis of Hp eradication, and to discuss the prognostic value of glycosylated hemoglobin (Hb A1c) levels in patients with type 2 diabetes mellitus (T2DM) for Hp eradication. Methods: prospective study was used to study the patients with type 2 diabetes mellitus co-infected with Hp in the first Hospital of Jilin University from June 2016 to May 2017. Hb A 1c was measured in plasma or fingertip blood, and Hp infection was measured by carbon 14 breath test. All patients were subsequently treated with the same bismuth tetralogy for Hp eradication, and the eradication was reexamined by the carbon-14 breath test at least 28 days after the end of the treatment. Results: a total of 45 patients, 25 males and 20 females, were successfully treated and 17 failed. There was no significant difference between sex and age in univariate analysis. There was significant statistical significance in HbA1c level (P0.001). Multivariate regression analysis showed that there was no significant statistical significance between sex and age (P0.003 OR4.730). The best positive predictive value (cut-off) for the maximum Jorden index pair was Hb A1c0. 5500, and the predictive index was 0. 3548. Conclusion the long-term blood glucose fluctuation in type 1.2 diabetes mellitus is an important factor in the prognosis of Hp eradication. High Hb A1c level is a risk factor for failure of Hp eradication in type 2 diabetic patients. If Hb A1c level "g8.55 or predictive index" g0.36 in type 2 diabetic patients, the risk of eradication failure is high, and eradication therapy is not recommended in the short term.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R587.1;R573

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