幽门螺杆菌再感染率及其影响因素研究
发布时间：2018-07-27 21:02
【摘要】：目的:2015年幽门螺杆菌(Helicobacter plori,H.pylori)胃炎京都共识及2016年H.pylori感染管理的马斯特里赫特V(Maastricht V)共识均将H.pylori胃炎定义为一种传染病,其传播途径可能为口-口或粪-口传播。不同国家和地区H.pylori再感染率不同,目前国内缺乏大宗病例的报道,河北地区尚无H.pylori再感染率以及其影响因素的研究,本研究旨在探讨河北石家庄地区H.pylori的再感染率及其影响因素,以对患者进行更合理的诊治提供有效的参考。方法:1病例选择病例选择2010年6月1日至2016年6月1日确认H.pylori成功根除后的患者,共350例。其中女性为184例,男性为166例,平均年龄(45.07±12.02)岁。1.1入选标准:(1)年龄在18-70岁之间,所有确认H.pylori成功根除后的350例患者进行快速尿素酶试验(RUT)或13C尿素呼吸试验(13C-UBT)及14C尿素呼吸试验(14C-UBT)。(2)成功根除后按随访时间复查者;(3)治疗结束后符合下列条件之一即为根治成功:(1)13C-尿素呼气试验或14C-尿素呼气试验阴性;(2)在胃窦、胃体两个部位取材的快速尿素酶试验检查均需H.pylori阴性[1]。(4)入组前所有患者对研究方案知情并签署知情同意,经河北医科大学第三医院伦理道德委员会同意。1.2排除标准:(1)心肺肝肾功能严重损害。(2)恶性肿瘤。(3)有1次以上H.pylori根除治疗或1个月内有抗生素治疗史者。(4)有胃大部切除手术史者。(5)成功根除后未按随访时间复查者。2方法2.1试验方法:对纳入研究的350例H.pylori成功根除后的患者,根据随访时间行RUT或13C-UBT及14C-UBT,观察H.pylori成功根除后1年内阳性率及1年后H.pylori再感染率的情况,将1年后的患者分为两组,H.pylori再感染组和持续保持阴性组,分析影响H.pylori再感染的因素。2.2记录患者一般资料记录患者姓名、性别、年龄、吸烟、饮酒、文化程度、家庭住址、家庭月收入、暴露(即与h.pylori感染者密切接触)情况;成功根除h.pylori后6个月内、6个月至1年、1年至2年、2年-3年、3年-4年、4年-5年、5年-6年检测h.pylori再感染情况。2.3统计方法:利用spss21.0软件对数据进行分析,计数资料以百分率表示,再感染率的比较采用χ2检验,p0.05为差异有统计学意义;计量资料数据方差不齐的运用非参数秩和检验,检验水准取α=0.05,p0.05为差异有统计学意义;影响因素分析采用二元logistic回归分析,b0,or1为危险因素,p0.05为差异具有统计学意义。结果:1.1随访应答率对纳入研究的350例h.pylori成功根除后的患者,一年内随访中失访0例,应答率为100%;其中共有327例患者持续保持阴性纳入第二年至第六年随访研究,第二年随访中失访4例,应答率为98.77%;第三年随访中累计失访10例,应答率为96.94%;第四年随访中累计失访18例,应答率为94.49%;第五年随访中累计失访23例,应答率为92.66%;第六年随访中累计失访28例,应答率为91.43%。1.2h.pylori根治后再感染率情况h.pylori根除后的再感染情况如table1及table2所示,随访六个月、六个月至一年,h.pylori出现阳性例数共23例,其中六个月内350例患者中出现14例阳性,六个月至一年内336例患者中出现9例阳性,h.pylori累积(年)阳性率分别为4.00%、6.68%(2.68%);第二年至第六年h.pylori出现阳性例数共13例,其中第二年出现5例阳性,第三年出现3例阳性,第四年出现2例阳性,第五年出现2例阳性,第六年出现1例阳性,h.pylori年累计(年)再感染率分别为1.53%、2.47%(0.94%)、3.12%(0.65%)、3.79%(0.67%)、4.13%(0.34%),经卡方检验p0.05,这5年h.pylori再感染率差别无统计学意义;其中随访六个月、六个月至第一年的h.pylori再感染率高于第一年以后各年(p0.05)。由此可见,h.pylori根除后的人群可再次感染h.pylori,再感染率很低,其h.pylori感染第一年内出现阳性率高于第一年后各年的再感染率,一年后再感染率维持相对稳定,年再感染率为0.82%。1.3 H.pylori再感染率的影响因素:单因素分析:病例在18~31岁、32~45岁、46~57岁、58~70岁,4个年龄分层均有分布,年龄分布对H.pylori再感染率无统计学意义(P=0.383),性别对H.pylori再感染率无统计学意义(P=0.074),吸烟对H.pylori再感染率无统计学意义(P=0.718),饮酒对H.pylori再感染率无统计学意义(P=0.064),教育水平对H.pylori再感染率无统计学意义(P=0.565),居住地对H.pylori再感染率无统计学意义(P=0.094),暴露因素对H.pylori再感染率有统计学意义(P=0.001),家庭月收入水平对H.pylori再感染率有统计学意义(P=0.047)(见Table3),其中,13例再感染患者处于暴露因素中占11例(84.7%),家庭月收入水平5000元者10例占(69.2%)。经二元Logistic回归多因素分析分析发现暴露因素(P=0.004,B=1.701,OR=5.482)、家庭月收入水平为再感染的危险因素(P=0.033,B=1.369,OR=3.932)(见Table4)。结论:1 H.pylori根除后存在再次感染的情况,年再感染率较低,为0.83%,5年内年再感染率维持相对稳定。2暴露因素、家庭月收入水平低为影响H.pylori再感染的危险因素。
[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.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R573.3
本文编号：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.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R573.3
【参考文献】
相关期刊论文 前10条
1 张铁民;张天哲;朱红丽;陈晓青;陈银苹;;我国儿童HLA-DQB1基因多态性与幽门螺杆菌感染关系的Meta分析[J];中国煤炭工业医学杂志;2015年08期
2 蒋承霖;蔡奇志;毛文灏;阮华良;郑秀金;;共同治疗策略对根除幽门螺杆菌的影响[J];临床消化病杂志;2014年04期
3 郝波;程文芳;张国新;施瑞华;;~(13)C-呼气红外光谱仪在诊断幽门螺杆菌感染中的应用[J];江苏医药;2014年05期
4 赖跃兴;朱佳莉;徐萍;李清华;吴杰;;口腔幽门螺杆菌感染对胃幽门螺杆菌根除和复发的影响[J];实用医学杂志;2014年02期
5 蔡奇志;蒋承霖;;幽门螺杆菌家庭聚集现象与家庭成员共治的关系研究[J];临床荟萃;2013年12期
6 Han-Yi Song;Yan Li;;Can eradication rate of gastric Helicobacter pylori be improved by killing oral Helicobacter pylori ?[J];World Journal of Gastroenterology;2013年39期
7 绽永华;彭娜娜;;大蒜素、阿莫西林、埃索美拉唑、呋喃唑酮四联疗法治疗Hp阳性十二指肠溃疡效果观察[J];山东医药;2013年10期
8 刘文忠;谢勇;成虹;吕农华;胡伏莲;张万岱;周丽雅;陈烨;曾志荣;王崇文;萧树东;潘国宗;胡品津;;第四次全国幽门螺杆菌感染处理共识报告[J];现代消化及介入诊疗;2012年06期
9 荣海芹;;幽门螺杆菌感染儿童及家庭成员同步治疗的疗效分析[J];临床误诊误治;2012年10期
10 高文;胡伏莲;王晓敏;;含呋喃唑酮的四联疗法联合口腔洁治对幽门螺杆菌根除多次失败的补救治疗[J];中华医学杂志;2011年12期
相关硕士学位论文 前1条
1 马锋;抑制口腔幽门螺杆菌的中药组方的研制[D];南方医科大学;2011年
，本文编号：2149127
本文链接：https://www.wllwen.com/yixuelunwen/xiaohjib/2149127.html
最近更新
教材专著
