CAJ | 학술논문

目的：探讨幽门螺杆菌（ Hp）感染对颈动脉粥样硬化患者颈动脉内膜中层厚度（ CIMT）、斑块易损性以及同型半胱氨酸（ Hcy）代谢的影响。方法选取行颈动脉彩超提示颈动脉粥样硬化的知情同意者129例，采用14 C尿素呼气试验检测入选对象的Hp感染情况，同时采用循环酶法测定其血清Hcy水平。结果颈动脉粥样硬化患者中Hp感染者血清Hcy水平和CIMT高于Hp阴性者（P均＜0．01），且随着患者体内Hp感染程度的加重，其血清Hcy水平及CIMT亦相应增高（P均＜0．01）。 Hp不同感染程度各组血清Hcy水平及CIMT差异均有统计学意义（P＜0．01）。 Hp感染组斑块检出率高于Hp阴性组（P＜0．05），且Hp感染组易损斑块的发生率明显高于Hp阴性组（ P＜0．05）。 Logistic回归分析显示，在斑块性颈动脉粥样硬化患者中，Hp感染者并发易损斑块可能性是Hp阴性者的2．35倍；血清Hcy每升高1μmol／L，发生易损斑块的可能性增加9％。结论 Hp感染可能通过影响Hcy代谢以及增加CIMT和颈动脉硬化斑块的不稳定性，促进动脉粥样硬化的发生和进展。
목적：탐토유문라간균（ Hp）감염대경동맥죽양경화환자경동맥내막중층후도（ CIMT）、반괴역손성이급동형반광안산（ Hcy）대사적영향。방법선취행경동맥채초제시경동맥죽양경화적지정동의자129례，채용14 C뇨소호기시험검측입선대상적Hp감염정황，동시채용순배매법측정기혈청Hcy수평。결과경동맥죽양경화환자중Hp감염자혈청Hcy수평화CIMT고우Hp음성자（P균＜0．01），차수착환자체내Hp감염정도적가중，기혈청Hcy수평급CIMT역상응증고（P균＜0．01）。 Hp불동감염정도각조혈청Hcy수평급CIMT차이균유통계학의의（P＜0．01）。 Hp감염조반괴검출솔고우Hp음성조（P＜0．05），차Hp감염조역손반괴적발생솔명현고우Hp음성조（ P＜0．05）。 Logistic회귀분석현시，재반괴성경동맥죽양경화환자중，Hp감염자병발역손반괴가능성시Hp음성자적2．35배；혈청Hcy매승고1μmol／L，발생역손반괴적가능성증가9％。결론 Hp감염가능통과영향Hcy대사이급증가CIMT화경동맥경화반괴적불은정성，촉진동맥죽양경화적발생화진전。
Objective To investigate the influence of Helicobacter pylori ( Hp) infection on carotid intima-media thickness( CIMT ) , plaque stability and the metabolism of homocysteine ( Hcy ) in carotid atherosclerosis patients. Methods According to carotid artery ultrasonography, 129 patients with carotid atherosclerosis were enrolled.14 C urea breath test was used to determine Hp infection.Meanwhile, enzymatic cycling method was used to determine serum Hcy levels .Results Serum Hcy levels and CIMT of patients with carotid atherosclerosis in Hp infection group were higher than those in Hp non-infection group (P<0.01), and they increased with the severity of Hp infection with statistical significance (P<0.01).The plaque detection rate in Hp infection group was higher than that of Hp non-infection group (P<0.05), and the incidence of vulnerable plaques in Hp infection group was obviously higher than that in Hp non-infection group(P<0.05).Logistic regression analysis showed that the possibility of vulnerable plaques in Hp infection group was 2.35 times higher than that in Hp non-infection group.With serum Hcy increasing by 1 μmol/L, the possibility of vulnerable plaque increased by 9%.Conclusions Hp infection is likely to promote the development and progression of carotid atherosclerosis through influencing Hcy metabolism and increasing CIMT and the instability of carotid atherosclerotic plaque.