幽门螺杆菌感染与缺血性卒中及其亚型的相关性研究

目的 对幽门螺杆菌（Helicobacter pylori，Hp）与缺血性卒中（ischemic stroke，IS）及其亚型的相关性进行探讨。方法 将纳入的123例IS患者根据2007年改良的TOAST分型标准进行病因学分型，其中动脉粥样硬化血栓形成（atherothrombosis，AT）94例、心源性栓塞（cardioembolism，CE）14例、小动脉病变（small arterydisease，SAD）12例，同时从门诊查体人群中随机抽取131例无心、脑及周围动脉粥样硬化血管病史的观察对象作为对照组。所有观察对象均记录Hp感染的潜在危险因素及传统IS危险因素。用酶联免疫吸附法测定血清Hp特异性抗体IgG。采用Logistic回归模型进行多因素分析。结果 病例组Hp-IgG阳性率高于对照组，但差异无统计学意义（69.1% vs 61.8%，OR =1.381，P = 0.2 23），校正H p感染的潜在危险因素及I S相关危险因素后，两者间差异仍无统计学意义（OR =1.284，P =0.413）。在亚型研究中也得出相似结果（AT：OR =1.455，P =0.193；CE：OR =1.111，P =0.857；SAD：OR =1.852，P =0.366）。校正相关因素后差异仍无统计学意义（AT：OR =1.441，P =0.297；CE：OR =0.894，P =0.864；SAD：OR =1.836，P =0.437）。结论 Hp感染与IS无明确相关性，仍需更多大样本及前瞻性研究进一步探讨Hp在IS及其亚型发病中的作用。

Study on the Association Between Helicobacter pylori Infection and Ischemic Stroke Subtypes

Objective The aim of our study was to investigate the association between helicobacter pylori （Hp） infection and ischemic stroke Subtypes.
Methods Total of 123 patients with ischemic stroke were enrolled. Analyses were stratified for etiologic stroke subtypes according to 2007 modified TOAST criteria： 94 patients with atherothrombosis （AT）, 14 patients with cardioembolism （CE）, 12 patients with small artery disease （SAD）. 131 control subjects without clinical and instrumental evidence of atherosclerosis diseases were randomly selected from clinic. All subjects were recorded potential risk factors for Hp infection and traditional risk factors for IS. The serumal specific antibody IgG of lip was detected by enzyme-linked immunosorbent assay （ELISA）. Conditional logistic regression was used.
Results Hp-lgG-positive rate of patient group was higher, but the difference was not statistically significant （69.1% vs 61.8%, OR=1.381, P-0.223）. This result remained no significant after adjusting for potential risk factors for Hp infection and known risk factors for IS （OR 1.284, 95%CI 0.705-2.338, P=0.413）. Subgroup analyses yielded similar results in all etiologic stroke subtypes （univariate analysis： AT： OR 1.455, 95%CI 0.827-2.561, P=0.193; CE： OR 1.111, 95%C1 0.352-3.504, P=0.857; SAD： OR 1.852, 95%CI 0.478-7.167, P=0.366; Multivariate analysis： AT： OR 1.441, 95%CI 0.726-2.861, P=0.297; CE： OR 0.894, 95%CI 0.249-3.211, P=0.864; SAD： OR 1.836, 95%CI 0.396-8.503, P=0.437）. Conclusion Our case-control study does not provide evidence of any strong association between Hp chronic infection and IS. There is still need for large case-control and mainly prospective studies to investigate the contribution of Hp infection to 1S risk particularly subgroups.