幽门螺杆菌阴性消化性溃疡与出血关系的多中心对照研究
유문라간균음성소화성궤양여출혈관계적다중심대조연구
Helicobacter pylori negative peptic ulcer and ulcer bleeding:a multi-center case-control study in China mainland
  • 万方数据
    中华消化内镜杂志 중화소화내경잡지
    CHINESE JOURNAL OF DIGESTIVE ENDOSCOPY
    2010年 8期 410-414 ,共5页

    刁萍萍%杜奕奇%李兆申%李淑德%舒建昌%陈锡美%周中杰%陆和平%姜慧卿%刘希双%鲁临%杨力%时昭红%刘鹏飞%屠惠明%陈国昌%张志坚

    조평평%두혁기%리조신%리숙덕%서건창%진석미%주중걸%륙화평%강혜경%류희쌍%로림%양력%시소홍%류붕비%도혜명%진국창%장지견

    出血,消化性溃疡%幽门螺杆菌 齣血,消化性潰瘍%幽門螺桿菌
    출혈,소화성궤양%유문라간균
    Hemorrhage,peptic ulcer%Helicobacter pylori
    目的 明确中国大陆地区幽门螺杆菌(Hp)阴性消化性溃疡与出血的关系.方法 拟定于2006年4月至2007年3月期间在国内14个研究中心中进行,每个中心预期调查30例经急诊内镜诊断为胃溃疡和(或)十二指肠溃疡合并出血的患者(PUB组),同时调查30例不伴出血的胃溃疡和(或)十二指肠溃疡患者作为对照(PU组).共拟入选840例患者,消化性溃疡合并及不合并出血组各420例.在内镜检查中采用快速尿素酶试验和病理检测Hp感染,并对初次检查Hp阴性者于1个月后进行尿素呼气试验复查.结果 共617例患者纳入分析,其中PUB组263例、PU组354例,2组在性别比、平均年龄等一般状况方面差异无统计学意义(P均＞0.05).PUB组Hp阳性率61.2%(161/263)显著低于PU组的87.9%(311/354)(P＜0.001);PUB组Hp阳性的溃疡出血发生复合溃疡的比例7.5%(12/161)显著高于Hp阴性溃疡出血者1.0%(1/102)(P=0.018),但两者在平均发病年龄、性别比、呕血发生率、十二指肠球部溃疡发生率、胃溃疡发生率及溃疡平均直径方面差异无统计学意义(P均＞0.05).对于初次Hp阴性的溃疡出血患者,1个月后的呼气试验复查未发现阳性病例.结论 目前中国大陆Hp阴性溃疡在消化性溃疡出血中的比例较高,Hp阴性溃疡可能更容易并发消化道出血,需要引起消化专科医生的重视.
    목적 명학중국대륙지구유문라간균(Hp)음성소화성궤양여출혈적관계.방법 의정우2006년4월지2007년3월기간재국내14개연구중심중진행,매개중심예기조사30례경급진내경진단위위궤양화(혹)십이지장궤양합병출혈적환자(PUB조),동시조사30례불반출혈적위궤양화(혹)십이지장궤양환자작위대조(PU조).공의입선840례환자,소화성궤양합병급불합병출혈조각420례.재내경검사중채용쾌속뇨소매시험화병리검측Hp감염,병대초차검사Hp음성자우1개월후진행뇨소호기시험복사.결과 공617례환자납입분석,기중PUB조263례、PU조354례,2조재성별비、평균년령등일반상황방면차이무통계학의의(P균＞0.05).PUB조Hp양성솔61.2%(161/263)현저저우PU조적87.9%(311/354)(P＜0.001);PUB조Hp양성적궤양출혈발생복합궤양적비례7.5%(12/161)현저고우Hp음성궤양출혈자1.0%(1/102)(P=0.018),단량자재평균발병년령、성별비、구혈발생솔、십이지장구부궤양발생솔、위궤양발생솔급궤양평균직경방면차이무통계학의의(P균＞0.05).대우초차Hp음성적궤양출혈환자,1개월후적호기시험복사미발현양성병례.결론 목전중국대륙Hp음성궤양재소화성궤양출혈중적비례교고,Hp음성궤양가능경용역병발소화도출혈,수요인기소화전과의생적중시.
    Objective The primary aim of this study was to examine the proportion and natural history of Helicobacter pylori (Hp) negative bleeding peptic ulcers. Methods The study was designed as a multiple-center, case-control study conducted in 14 endoscopy centers in China from April 2006 to March 2007. Each center was expected to recruit 30 peptic ulcer patients with bleeding ( PUB group) and 30 without (PU group). All screened patients with upper gastrointestinal bleeding received endoscopy within 24 hours of admission. Biopsy specimens were taken from the antrum to determine Hp infection by rapid urease test and pathology. Patients with negative Hp infection at first examination were asked to receive urease breathe test (UBT) one month later. Results A total of 617 patients were enrolled with 263 in PUB group and 354 in PU group. There is no significant difference in demographic characters between 2 groups ( P ＞0. 05). The rate of Hp infection in PUB group ( 161/263, 61.2% ) was significantly lower than that in PUgroup (311/354, 87. 9%, P ＜0. 001 ). The incidence of complex ulcer in Hp positive PUB patients was 7.5% ( 12/161 ), which is significantly higher than that in Hp negative PUB patients ( 1/102, 1.0% , P =0. 018). In PUB group, no significant differences were found between Hp positive and negative patients in regarding of age, sex, rates of haematemesis, duodenal ulcer and gastric ulcer, and size of ulcer ( P ＞0. 05 ). Among 102 Hp negative cases in PUB, no positive case was found in UBT one month later. Conclusion We have demonstrated a rise in the incidence of Hp negative bleeding ulcers in China. The idiopathic ulcer was not rare, and might have a higher tendency to cause bleed.
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