体检人群幽门螺杆菌感染对胰岛素抵抗及糖脂代谢的影响

发布时间：2018-12-16 06:48

【摘要】：目的目前,幽门螺杆菌(Heliobacter pylori,H.pylori,Hp)在我国普通人群的感染率高达50%-80%,并且以每年1%~2%的速度增加。H.pylori感染参与了体内许多疾病的发生、发展。随着对H.pylori研究的越来越深入,发现H.pylori与胰岛素抵抗和糖脂代谢密切相关。目前关于H.pylori感染与胰岛素抵抗之间关系的研究,大多是针对临床上已确诊的疾病如糖尿病、心血管疾病等。而本研究针对健康人群或者未出现疾病前期的体检人群中就H.pylori感染对于机体胰岛素抵抗和其他代谢指标的影响做了详细的研究,探讨H.pylori感染对于血糖、血脂及胰岛素抵抗的影响。方法在2016年1月至2016年11月于天津医科大学总医院保健医疗部健康体检中心随机选取体检者620例,根据研究的排除标准及剔除其中数据不全者,最终选取594例体检者,年龄20-83周岁,平均年龄为52.2±12.7岁,其中男性273例,女性321例。抽取静脉血检测血糖、血脂及肝、肾功能等指标,采用~(13)C-尿素呼气试验(~(13)C-UBT试验)检测判定Hp感染情况,采用稳态模型(HOMA-IR)评估胰岛素抵抗的情况胰岛素抵抗指数(HOMA-IR)=空腹血糖FPG(mmol/L)×空腹血浆胰岛素FINS(m IU/L)/22.5。将研究对象按Hp感染情况分为Hp阳性组和Hp阴性组,从而分析人群中H.pylori感染情况及对比两组之间血糖、血脂及胰岛素抵抗情况的不同;根据化验血糖的结果,分为糖代谢异常组(包括糖耐量受损者及糖尿病者)及健康对照组,分析两组人群中H.pylori感染情况,及探讨糖代谢异常人群合并H.pylori感染时的胰岛素抵抗水平、血糖和血脂等水平;用Logistic回归模型分析H.pylori感染是否是胰岛素抵抗的危险因素。结果1.在594例体检人员中,Hp感染率为61.1%,经统计学分析发现,Hp感染在性别及年龄之间均无统计学差异(p=0.675,p=0.770)。将所有受试者根据年龄分层后分析发现,在每个年龄层中Hp感染率均在60%左右,并且随着年龄增加Hp感染率没有显著变化。2.根据Hp不同感染情况分组发现,Hp阳性组中的FBG、Hb A1c明显升高,HDL明显降低,差异具有统计学意义(p=0.037,p=0.035,p=0.004),并且HOMA-IR在Hp阳性组明显高于Hp阴性组(p0.05),通过采用不同HOMA-IR上限值进行研究发现,三种情况下Hp感染者中均存在IR。进一步根据糖代谢受损情况进行分组分析发现,糖代谢异常组Hp阳性者胰岛素抵抗较Hp阴性者明显,差异有统计学意义,在健康对照组中Hp阳性者胰岛素抵抗虽有增高,但差别没有统计学意义。3.Logistic回归分析Hp感染是增加胰岛素抵抗的危险因素之一。结论在体检人群中,尤其是在糖代谢异常者中,Hp感染与胰岛素抵抗及糖脂代谢之间的确存在着密切联系。Hp感染是增加胰岛素抵抗的危险因素。
[Abstract]:Objective at present, the infection rate of Helicobacter pylori (Heliobacter pylori,H.pylori,Hp) in the general population in China is as high as 50-80%, and it increases at a rate of 1% or 2% per year. H.pylori infection is involved in the occurrence and development of many diseases in the body. With the further study of H.pylori, it is found that H.pylori is closely related to insulin resistance and glycolipid metabolism. At present, the research on the relationship between H.pylori infection and insulin resistance is focused on clinically confirmed diseases such as diabetes mellitus, cardiovascular disease and so on. In this study, the effects of H.pylori infection on insulin resistance and other metabolic parameters were studied in the healthy population or those who did not have pre-disease, and the effect of H.pylori infection on blood glucose was discussed. Effects of serum lipids and insulin resistance. Methods from January 2016 to November 2016, 620 patients were randomly selected from the Health examination Center of the Department of Health Care, General Hospital of Tianjin Medical University. According to the exclusion criteria of the study and excluding the incomplete data, 594 medical examiners were selected. The average age was 52.2 卤12.7 years, including 273 males and 321 females. Blood glucose, blood lipids, liver and kidney function were measured in venous blood samples, and Hp infection was determined by ~ (13) C-urea breath test (~ (13) C-UBT test). Insulin resistance index (HOMA-IR) = fasting blood glucose FPG (mmol/L) 脳 fasting plasma insulin FINS (m IU/L / 22.5 was evaluated by steady-state model (HOMA-IR). The subjects were divided into Hp positive group and Hp negative group according to the Hp infection, so as to analyze the prevalence of H.pylori infection and compare the differences of blood glucose, blood lipid and insulin resistance between the two groups. According to the results of blood glucose test, the patients with abnormal glucose metabolism (including impaired glucose tolerance and diabetes mellitus) and the healthy control group were divided into two groups. The levels of insulin resistance, blood glucose and lipids in patients with abnormal glucose metabolism complicated with H.pylori infection were discussed. Logistic regression model was used to analyze whether H.pylori infection was a risk factor of insulin resistance. Result 1. The infection rate of Hp was 61.1 in 594 people. The results of statistical analysis showed that there was no significant difference between sex and age in Hp infection (p0. 675 / 0. 770). According to the age stratification analysis, the Hp infection rate was about 60% in each age group, and there was no significant change in Hp infection rate with the increase of age. 2. According to the different infection status of Hp, the FBG,Hb A1c in Hp positive group was significantly increased, and HDL was significantly decreased (p0.037%, 0.035%, p0.004), the difference was statistically significant (p0. 037%, p0. 035%, p0. 004). HOMA-IR was significantly higher in the Hp positive group than in the Hp negative group (p0.05). By using different HOMA-IR upper limit values, it was found that there was IR. in all the Hp infected persons under all three conditions. According to the group analysis of impaired glucose metabolism, it was found that the insulin resistance of Hp positive group was significantly higher than that of Hp negative group, and the insulin resistance of Hp positive group in healthy control group was higher than that of Hp negative group. But the difference was not statistically significant. 3.Logistic regression analysis showed that Hp infection was one of the risk factors to increase insulin resistance. Conclusion there is a close relationship between Hp infection and insulin resistance and glycolipid metabolism in physical population, especially in patients with abnormal glucose metabolism. Hp infection is a risk factor to increase insulin resistance.
【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R57

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