幽门螺杆菌感染与肝硬化门脉高压性胃病伴出血的相关性研究

目的探讨幽门螺杆菌（Helicobacter pylori,HP）感染与肝硬化门脉高压性胃病（portal hypertensive gastropathy,PHG）及其并发上消化道出血的关系。方法对115例肝硬化门脉高压性胃病患者（其中55例并发上消化道出血）的临床特征进行总结分析。结果 PHG组患者的HP感染率为30.4%,显著低于慢性胃炎组47.7%（P〈0.05）;HP在轻型PHG组的阳性率是38.2%,略高于重型PHG组的25.9%,但差异无统计学意义;未发现HP感染与上消化道出血的发生及严重程度的相关性;随着肝功能的恶化,HP感染率显著降低（P〈0.05）,且PHG并上消化道出血的发生率显著升高（P〈0.01）。结论 PHG不能为HP提供赖以生存和繁殖的内环境;HP感染与PHG及其并发上消化道出血的发生和严重程度没有明显的相关性,故不必把根除幽门螺杆菌作为对PHG及并发上消化道出血患者的常规处理措施;肝功能与PHG及出血并发症的显著相关性提示一切有损于肝功能的因素均需给予重视并进行严格的统计分析。

Correlations of Helicobacter pylori Infection with Portal Hypertensive Gastropathy and Its Complicated Upper Gastrointestinal Hemorrhage in Patients with Liver Cirrhosis

Objective The current study was conducted to ascertain the prevalence of Helicobacter pylori（HP） in patients with portal hypertensive gastropathy（PHG）and determine whether it contribute to the presence and /or the severity of the disease as well as the complicated upper gastrointestinal hemorrhage.Methods A total of 115 consecutive patients presented with PHG were included in the study,of which 55 patients were complicated with upper gastrointestinal bleeding and 60 patients without.The severity of PHG was graded endoscopically according to McCormack＇s criteria while that of upper gastrointestinal hemorrhage can be evaluated in terms of the amount of bleeding.HP status was determined by means of a rapid urease test and also by the C14 urea breath test or the anti-HP IgG levels.Results The rate of HP infection was lower in patients with PHG（30.4%） than that in patients with chronic gastritis（47.7%,P0.05）.HP positive rate was higher in mild PHG（38.2%）than that in severe PHG（25.9%）,although this did not reach statistical significance.No correlation was found between HP infection and the incidence and severity of bleeding in patients with PHG.The rate of HP infection decreased markedly（P0.05） and the incidence of upper gastrointestinal bleeding increased dramatically（P 0.01）with the aggravation of liver dysfunction.Conclusions The HP infection appears to be not significant for the presence and severity of PHG with or without bleeding in cirrhotic patients.Hence,there might be no need for its routine eradication in patients with PHG who are or aren＇t complicated with upper gastrointestinal hemorrhage.Furthermore,the marked correlation between liver function and the severity of PHG as well as its complicated upper gastrointestinal hemorrhage suggests that factors correlate to liver dysfunction should be further analyzed.