Hp感染与服用NSAIDs关系的研究进展

Hp感染和服用NSAIDs两种因素均可导致胃十二指肠粘膜的损伤，本综述这两种因素在胃十二指肠粘膜损伤中关系的研究进展。     

Hp感染与服用NSAIDs关系的研究进展

Hp感染和服用NSAIDs两种因素均可导致胃十二指肠粘膜的损伤,本文综述这两种因素在胃十二指肠粘膜损伤中关系的研究进展。     

非甾体抗炎药物致老年人上消化道出血60例

[目的]探讨老年人服用非甾体抗炎药致上消化道出血的风险。[方法]回顾性分析2003年8月至2009年8月收治的因服用非甾体抗炎药致上消化道出血老年患者60例的临床资料。[结果]经过4～8周治疗,60例患者呕血、黑便停止,大便隐血试验阴性。上腹胀痛、上腹隐痛、上腹不适、返酸、嗳气、恶心、呕吐较入院时明显缓解。2个月后复查胃镜,胃、十二指肠球部溃疡、糜烂均痊愈。[结论]老年人服用非甾体抗炎药存在一定的上消化道出血风险,使用时应严格适应证,定期复查,尽量选用高选择性的环氧化酶抑制剂。     

埃索美拉唑防治非甾体类抗炎药所致老年人上消化道出血的疗效观察

目的探讨早期应用埃索美拉唑防治非甾体类抗炎药（NSAIDs）所致老年人上消化道出血的疗效。方法将80例服用NSAIDs的老年人分为埃索美拉唑组（40例）和法莫替丁组（40例）,观察2组患者上消化道出血的发生率,监测给药后第2、4、6天胃液pH值。结果在埃索美拉唑组,34例患者无明显上消化道出血发生,5例发生少量出血,显效率为85.0%,总有效率为97.5%;在法莫替丁组,8例患者发生明显出血,13例发生少量出血,显效率为47.5%,总有效率为80.0%,2组比较,差异有统计学意义（P〈0.01）。治疗第2、4、6天,埃索美拉唑组胃液pH值均明显高于法莫替丁组（5.44±0.67比4.18±0.72、5.61±0.71比4.85±0.85、5.74±0.63比5.13±0.79,P均〈0.01）。结论早期应用埃索美拉唑可显著降低NSAIDs所致老年人上消化道出血的发生率,明显提高其胃液pH值。     

老年人服用非甾体类抗炎药致上消化道出血的临床特征

目的探讨老年人服用非甾体类抗炎药(NSAIDs)致上消化道出血的临床及内镜特征。方法回顾性分析2003～2007年5年因上消化道出血住院患者的临床资料,依据1周内是否服用过NSAIDs,分为NSAIDs组和非NSAIDs组,对临床资料及内镜检查结果进行对比分析。结果 753例非食管胃静脉曲张上消化道出血住院患者中有76例(10.1%)发病前1周内有服用过NSAIDs药物史。比较两组患者性别、幽门螺杆菌感染情况,出血程度等差异无统计学意义(P0.05),但NSAIDs组年龄明显偏大,伴有心脑血管病和骨关节病,出血前常无消化道症状,与非NSAIDs组相比差异有统计学意义(P0.01)。NSAIDs组内镜检查以胃溃疡和糜烂出血为主要病变,与非NSAIDs组相比有非常显著性差异(P0.01)。结论老年人应尽量减少NSAIDs的使用,必须服用者应注意观察上消化道症状,必要时加服胃黏膜保护剂干预以减少或预防胃肠道不良反应。     

老年人消化性溃疡与Hp感染、服用非甾体消炎药的关系

目的探讨老年人消化性溃疡(PU)及其常见并发症出血与幽门螺杆菌(Hp)感染、服用非甾体消炎药(NSAIDs)之间的关系。方法采用病例对照分析方法,收集60岁以上老年消化性溃疡病(PUD)连续住院患者784例为研究组,再根据有无并发出血将研究组分为出血亚组(416例)与非出血亚组(368例);选同期住院的60岁及以上老年慢性胃炎患者261例为对照组,所有患者均经胃镜明确诊断,并进行Hp快速尿素酶试验,统计患者NSAIDs的服用情况。结果①研究组服用NSAIDs的百分率及Hp感染率均显著高于对照组(P<0.05);②研究组出血亚组服NSAIDs者的Hp阳性率(22.6%)低于未服NSAIDs者(73.8%)(P<0.05);③非出血亚组服NSAIDs者的Hp阳性率(30.0%)低于未服NSAIDs者(82.0%)(P<0.05);④研究组出血亚组中无论胃溃疡(GU)还是十二指肠溃疡(DU)患者服用NSAIDs百分率均高于非出血亚组(P<0.05);出血亚组中GU患者Hp感染率(62%)比非出血组(82.5%)明显降低(P<0.05),而出血亚组中DU患者Hp感染率(66.7%)与非出血组(70.6%)比较无明显差别(P>0.05)。结论①老年人PUD的发病与Hp感染及服用NSAIDs密切相关,②服用NSAIDs可以增加老年PUD出血的危险性,而Hp感染并不增加老年PUD出血的危险性。③老年人PUD(不论出血和非出血)服NSAIDs者Hp感染率降低。     

肝硬化上消化道出血和幽门螺杆菌感染的相关性研究

目的研究肝硬化患者幽门螺杆菌感染和上消化道出血之间的关系.方法肝硬化患者160例,内镜检查了解食管静脉曲张和消化性溃疡的发生情况及出血的原因,同时胃粘膜活检作尿素酶试验,检测幽门螺杆菌(Hp).结果Hp阳性组消化性溃疡发生率(64.1%)明显高于阴性组(37.8%,P＜0.01).出血率在Hp阳性组(38.5%)也明显高于阴性组(22%,P＜0.05).结论Hp感染和肝源性溃疡发生有关,Hp感染者的肝源性溃疡发生率增高及胃粘膜活动性炎症可能导致出血率升高,根除Hp有可能降低肝硬化上消化道出血.     

老年人非甾体抗炎药相关上消化道出血的临床特征

非甾体抗炎药（nonsteroidal anti—inflammatory drugs：NSAID）是一类具有抗炎、解热、镇痛及抗风湿作用的药物，上消化道出血是NSAID胃肠道损害的常见并发症。我们将2003年1月至2004年9月期间在我院诊治的上消化道出血病例进行了回顾性分析和随访，总结老年人NSAID相关上消化道出血的临床特征，现将结果报告如下。     

非甾体抗炎药致上消化道出血的临床特征

目的研究非甾体抗炎药(NSAIDs)致上消化道出血的临床特征.方法调查上海4家医院的上消化道出血住院患者的临床资料,根据出血前10d内是否服用过NSAIDs,将其分为两组进行比较.结果424例上消化道出血患者中有70例(16.51%)服用过NSAIDs.两组比较,患者的性别、消化道溃疡史、出血程度、病变大小及部位比较差异无显著性(P＞0.05);但NSAIDs组患者的年龄偏大,较多患者有消化道出血史、心血管病史,出血前消化道症状不明显,溃疡或糜烂更易多发,平均住院天数明显减少(P＜0.05).结论应采取适宜策略降低NSAIDs的不良反应.     

幽门螺杆菌感染和长期服用阿司匹林与上消化道出血关系研究

目的:探讨幽门螺杆菌(Hp)感染患者长期服用阿司匹林与上消化道出血的关系。方法:选取门诊每日服用100mg阿司匹林的患者,进行胃镜检查并检测Hp。根据Hp检测结果将3809例入选对象分为Hp阳性组和Hp阴性组,随访2年,观察上消化道出血情况;Hp阳性伴上消化道出血患者抗Hp治疗根除Hp后分组,分别给予法莫替丁40mg睡前顿服(干预组),或不加干预者作为对照组,2组均继续服用阿司匹林,随访2年,观察其再出血情况。结果:60岁以上老年患者服用小剂量阿司匹林上消化道出血率明显高于60岁以下患者(P<0.05);Hp阳性组2802例患者中上消化道出血146例(5.21%),Hp阴性组共1007例患者,上消化道出血为30例(2.98%),2组相比差异有统计学意义(P<0.05);144例患者根除Hp法莫替丁干预组72例,上消化道再出血2例(2.78%),对照组72例,上消化道再出血8例(11.1%),2组相比差异有统计学意义(P<0.05)。结论:60岁以上老年患者服用小剂量阿司匹林增加上消化道出血风险;Hp感染并长期服用小剂量阿司匹林可增加患者上消化道出血风险;法莫替丁干预能有效降低长期服用小剂量阿司匹林患者上消化道再出血风险。     

Should we eradicate Helicobacter pylori infection in patients receiving nonsteroidal anti‐inflammatory drugs or low‐dose aspirin?

Whether Helicobacter pylori infection alters the risk of ulcer disease in patients receiving nonsteroidal anti‐inflammatory drugs (NSAIDs) or low‐dose aspirin is one of the most controversial topics in peptic ulcer research. This is an important management issue, particularly in countries where peptic ulcer disease is common and the prevalence of H. pylori infection is high. Current evidence shows that H. pylori infection increases the ulcer risk associated with NSAIDs or low‐dose aspirin. Eradication of H. pylori reduces the subsequent risk of endoscopic and complicated ulcers in patients who are about to start long‐term NSAIDs. Among patients with H. pylori infection and a history of ulcer bleeding who continue to use low‐dose aspirin, 1 week of eradication therapy prevents recurrent ulcer bleeding. Failure of eradication and concomitant use of NSAIDs, however, account for most cases of recurrent bleeding with low‐dose aspirin. The apparent protective effect of H. pylori in long‐term NSAIDs users reported in some studies was actually the weeding out of susceptible patients who were intolerant to NSAIDs. There is no convincing evidence that eradication of H. pylori has any clinically important adverse effect on the healing and prevention of ulcers in NSAIDs users.     

幽门螺杆菌感染根除与老年消化性溃疡发生、复发关系的研究

目的　探讨老年消化性溃疡发生、复发与幽门螺杆菌 (Hp)感染的关系。方法　应用 PCR法对 78例老年性消化性溃疡幽门螺杆菌感染及幽门螺杆菌感染根除治疗后半年、 1年幽门螺杆菌再感染者进行了测定。结果　幽门螺杆菌检出率老年组明显高于青年组 ,Hp根治率青年组明显高于老年组 ,经 Hp根除治疗组溃疡愈合率明显高于未根除治疗组。结论　老年消化性溃疡发生与幽门螺杆菌感染密切相关 ,在溃疡治疗中 ,根除 Hp感染对减少溃疡复发具有重要临床意义     

幽门螺杆菌与消化性溃疡并出血的研究现状

幽门螺杆菌是消化性溃疡的确定性致病因素,其在溃疡并出血的作用尚不十分明确.目前,幽门螺杆菌在消化性溃疡并出血的感染率受检测方法、药物等影响不尽相同.幽门螺杆菌感染在一定程度上增加了消化性溃疡并出血的危险性,从长远上根除幽门螺杆菌可以降低溃疡出血风险,促进溃疡愈合.     

Helicobacter pylori infection in patients with haemophilia in Poland: prevalence and risk of upper gastrointestinal bleeding

Infection with Helicobacter pylori is the main aetiological factor for erosive gastritis and duodenal or gastric peptic ulcers often complicated with life-threatening bleeding in patients with coagulation disorders. The aim of this prospective study was to evaluate the prevalence of Helicobacter pylori infection in haemophilia patients, and to assess the risk of gastrointestinal bleeding associated with this infection. From 2000 to 2002, 146 patients with haemophilia (129, haemophilia A; 13, haemophilia B), mean age, 39.9 years (+/-7.3), were investigated for H. pylori infection using IgG and IgA latex serological test. The control group included 100 men with no coagulation disorders, mean age, 40.9 years (+/-9.2). For 72 (49.3%) patients with haemophilia and 39 controls (39.0%) serological tests were positive indicating the presence of H. pylori infection (P =0.1112). A history of gastrointestinal bleeding was reported in 46 patients (31.5%) with haemophilia and in two control group patients (2.0%) (P < 0.0001). Gastrointestinal bleeding was significantly more frequent in patients with haemophilia infected with H. pylori (33/46; 71.7%) than in patients with no H. pylori infection (13/46; 28.3%; P = 0.0002). In conclusion, the prevalence of H. pylori infection in haemophilic patients in Poland is comparable with that in patients with no coagulation disorders. Helicobacter pylori infection is a risk factor for duodenal and gastric ulcer bleeding in haemophilia patients. In view of the high frequency of upper gastrointestinal bleeding associated with H. pylori infection, we believe that screening and eradication therapy are appropriate in haemophilia patients.     

Continuous proton pump inhibitor treatment decreases upper gastrointestinal bleeding and related death in rural area in Japan

Background and Aims: Proton pump inhibitors (PPI) have been rarely used for prevention of upper gastrointestinal bleeding (UGIB) induced by non‐steroidal anti‐inflammatory drugs (NSAIDs) and/or aspirin in Japan. The increased incidence of UGIB in the aged society is becoming a serious problem. The aim of this study was to retrospectively evaluate whether PPI can prevent UGIB. Methods: We examined records of 2367 patients (aged 67.9 ± 15.1 years, male 1271) attending the only hospital serving the rural area, with little population movement. We investigated the correlation between the frequency of usage of medicine (PPI, histamine 2 receptor antagonists [H2RA], NSAIDs, aspirin) and incidence of UGIB over 12 years. UGIB was defined as cases with hematemesis and/or melena and definite bleeding at upper gastrointestinal endoscopy. The annual incidence of UGIB of inhabitants (16 065 ± 375.3 persons/year) was evaluated. The frequency of usage of medicine was compared with the total number of patients prescribed any medication (1080 ± 33.2 persons/year). Results: The frequency of PPI usage has increased significantly 4.6%→30.8% (P < 0.05). NSAIDs and aspirin usage increased significantly in the latter half of the survey period (P < 0.05). The annual incidence of UGIB significantly decreased 160.8 →23.6/100 000 inhabitants per annum (P ≤ 0.05) due to widespread use of PPI. No patients died due to UGIB after 2006. The incidence of UGIB and the prevalence of PPI usage were found to have a negative correlation (r = ?0.804, P = 0.0016). Conclusions: By widespread use of PPI, UGIB and related death has declined significantly. This survey showed that continuous PPI treatment decreases UGIB and related death in community medicine.     

Rapid urease test is less sensitive than histology in diagnosing Helicobacter pylori infection in patients with non-variceal upper gastrointestinal bleeding

BACKGROUND AND AIMS: The validity of the rapid urease (CLO) test to diagnose Helicobacter pylori infection in patients with bleeding ulcers has been questioned. The aim of this paper is to evaluate the validity of the CLO test in comparison with histology in diagnosing H. pylori infection in patients with acute upper gastrointestinal bleeding (UGB), irrespective of non-steroidal anti-inflammatory drug (NSAID) use. METHODS: Upper gastrointestinal endoscopy was performed within 24 h of admission for all patients with UGB admitted to the Department of Pathophysiology, Medical School, Athens, for a period of 12 months. Patients with variceal bleeding, previous gastric operation, recent treatment with proton pump inhibitors (< 2 months) and those with a history of H. pylori eradication therapy were excluded from the study. At least four biopsies (two from the antrum and two from the body) were obtained for the CLO test and histology (modified Giemsa). RESULTS: Seventy-two consecutive patients (aged 18-90 years, 51 men, 21 women) were included. Forty-six patients (64%) used NSAID. Thirty-two patients (44%) were found to be positive for H. pylori infection by the CLO test, while 44 patients (61%) were found to be positive on histology (P<0.045, 95% CI, 0.004-0.331). The sensitivity and specificity of the CLO test were 68 and 93% respectively; positive and negative predictive values were 94 and 65%, respectively. The age of the patient and visible blood in the stomach did not influence results of either the CLO or histology. CONCLUSIONS: The CLO test, performed within 24 h of hospital admission in patients with UGB, irrespective of NSAID use, is unreliable for the detection of H. pylori infection. The age of the patient and the presence of blood in the stomach do not seem to influence these results.     

Relationship between non-steroidal anti-inflammatory drug use and Helicobacter pylori infection in bleeding or uncomplicated peptic ulcers: A case-control study

BACKGROUND AND AIMS: Non-steroidal anti-inflammatory drug (NSAID) use has been closely associated with an increased risk of bleeding peptic ulcers, while the prevalence of Helicobacter pylori infection has been reported to be lower in bleeding ulcers than in non-bleeding ones. However, whether an interaction exists between NSAID use and H. pylori infection has not clearly been elucidated yet. The aims of this study were to determine the frequency of NSAID use and H. pylori infection, to predict risk factors in bleeding peptic ulcers and to determine whether NSAID use and H. pylori infection interact with each other. METHODS: Ninety-six patients with bleeding ulcer were included in the study. The control group consisted of 106 patients with non-bleeding ulcer. Data were analyzed by using the chi-squared test, Fisher's exact test and logistic regression analysis with or without interaction term (H. pylori by NSAID). RESULTS: Non-steroidal anti-inflammatory drug use was significantly more common in patients with bleeding ulcers than in controls (79.2 vs 38.7%, unadjusted odds ratio (OR): 6.02, 95% confidence interval (CI): 3.21-11.29). The frequency of the H. pylori infection was significantly lower in patients with bleeding ulcers than in controls (66.7 vs 89.6%, unadjusted OR: 0.23, 95% CI: 0.10-0.49). In the logistic regression analysis with the interaction term, male sex (adjusted OR: 3.70, 95% CI: 1.65-8.29), multiplicity of ulcers (adjusted OR: 4.10, 95% CI: 1.02-16.45) and NSAID use (adjusted OR: 33.87, 95% CI: 4.36-262.97) were independent risk factors for bleeding ulcers. There was a negative interaction between H. pylori and NSAID use (adjusted OR: 0.09, 95% CI: 0.01-0.83). CONCLUSIONS: The negative interaction between the two variables suggests that the presence of H. pylori is associated with a lower risk of bleeding in ulcer patients taking NSAIDs.     

冠心病病人HP感染的发生状况及其与血脂代谢的关系

目的 探讨冠心病病人幽门螺旋杆菌（HP）感染的发生及其与血脂代谢的关系。方法 选取2013年5月至2016年5月在我院治疗的冠心病患者150例（冠心病组）,同时选取在健康者100例作为对照组,采用14C尿素呼气试验检测Hp感染情况,并根据结果将冠心病患者分为未感染（n=76）、轻度感染（n=53）和重度感染（n=21）,同时根据SYNTAX评分将患者分为低危、中危和高危患者,测定各研究对象血脂水平。结果 冠心病组和对照组Hp感染率分别为49.33%和41.00%,比较差异无统计学意义（p＜＞0.05）;冠心病组TC、TG和LDL-C明显高于对照组,而HDL-C明显低于对组,差异比较有统计学意义（p＜0.05）;重度感染患者TC和TG明显高于未感染和轻度感染患者（p＜0.05）;重度感染和轻度感染患者HDL-C明显低于未感染患者（p＜0.05）,而LDL-C明显高于未感染患者（p＜0.05）;冠心病不同Hp感染患者中不同冠状动脉病变比例比较差异无统计学意义（p＞0.05）。结论 Hp感染与冠心病本身没有相关性,但Hp感染可能影响机体脂质代谢而促进冠心病发展。