幽门螺杆菌感染与2型糖尿病下肢动脉粥样硬化病变的相关性研究

目的通过观察2型糖尿病(T2DM)幽门螺杆菌(Hp)感染情况以研究Hp感染与T2DM患者下肢动脉粥样硬化病变(LEDA)的相关性，以及并发LEDA的危险因素。方法选择确诊为T2DM患者180例(DM组)，男性115例，女性65例，年龄58.64±10.98岁，其中无LEDA 96例、轻中度46例、重度38例。全部患者均符合WHO诊断标准。另选健康体检者90例为对照组。根据是否感染Hp，将T2DM组分为Hp阳性组和Hp阴性组，测定两组低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、三酰甘油(TG)、总胆固醇(TC)、血清脂蛋白相关磷脂酶A2(LP-PLA2)、糖化血红蛋白(HbA1c)、空腹血糖(FBG)、腰围(WC)及体重指数(BMI)进行比较。并对临床因素和生化指标与T2DM伴LEDA之间的相关性进行Logistic回归分析。结果T2DM组患者Hp感染率为62.22％(112/180)，高于健康对照组的48.89％(44/90)，差异有统计学显著性意义(χ２=14.189，P<0.05)。Hp阳性和Hp阴性患者之间的WC，BMI，HbA1c，FBG，LDL-C，HDL-C，TC，TG及性别、年龄差异均无统计学意义(t= 0.039～1.522，P值均＞0.05)，但Hp阳性组LP-PLA2水平明显高于Hp阴性组，差异有统计学意义(t=2.491，P＜0.05)。Hp感染在T2DM无下肢血管病变是46.88％(45/96)，伴轻中度下肢血管病变是71.74％(33/46)，重度是89.47%(34/38)，表明病变越重，Hp感染率越高，三组之间比较差异有统计学意义(χ２=23.397，P值<0.001)。Logistic回归分析表明，Hp感染和病程、吸烟、高血压及LDL-C均是T2DM发生LEDA的重要危险因素(OR=1.089～22.787，P值均<0.01)。结论T2DM比健康人群更容易感染Hp，Hp感染和病程、吸烟、高血压及LDL-C均是T2DM发生LEDA的危险因素。

Study on Correlation between HelicobacterPylori Infection and Lower Limb Artery AtheroscleroticLesions of Patients with Type 2 Diabetes Mellitus

ObjectiveTo study correlation both Helicobacter pylori (HP) infection and lower extremity atherosclerotic lesions (LEDA) of patients with type 2 diabetes mellitus (T2DM) by analysis in patients with T2DM and Hp infection，and discuss the risk factors for occurrence of LEDA in T2DM．MethodsDiagnosis of 180 patients with T2DM，male 115，65 female，age 58.64±10.98 years old，including 96 cases without LEDA and mild to moderate in 46 cases and 38 cases of severe were selected and the diagnostic criteria of WHO．Physical examination of 90 cases were as control group．According to whether the Hp infection，the T2DM group were divided into Hp positive and Hp negative group and determinations of two groups of low density lipoprotein cholesterol (LDL-C)，high density lipoprotein cholesterol (HDL-C) and triglyceride (TG)，total cholesterol (TC)，serum lipoprotein associated phospholipase A2 (Lp-PLA2)，glycosylated hemoglobin (HbA1c)，fasting blood glucose (FBG)，waistline (WC) and body mass index (BMI) were compared．The clinical factors，biochemical index and T2DM with LEDA were carried out by Logistic regression analysis．ResultsThe prevalence of Hp infection in type 2 diabetic patients 62.22％(112/180) was higher than that in normal controls 48.89％(44/90)，the difference there was statistical significant (χ２=14.189，P<0.05)．Between Hp positive and Hp negative patients，the WC，BMI，HbA1c，FBG，LDL-C，HDL-C，TC，TG and sex，age showed no statistical significant (t= 0.039～1.522，P＞0.05)，but Lp-PLA2 activity in Hp positive group was significantly higher than that of Hp negative group，the difference was statistically significant (t=2.491，P＜0.05)．Hp infection rate in T2DM patients without vascular lesions of lower limbs were 46.88％ (45/96) and 71.74% (33/46) respectively with mild to moderate， 89.47% (34/38) with severe vascular lesions of lower limbs．It showed that the Hp infection rate was higher for more serious the disease，the comparison among the difference was statistically significant (χ２=23.397，P<0.001)．Logistic regression analysis showed that，Hp infection and disease duration，smoking，high blood pressure and LDL-C were important risk factors for T2DM with LEDA (OR=1.089～22.787，P<0.01)．ConclusionThe results showed that patients with T2DM was more easily Hp infected than healthy people．Hp infection and disease duration，smoking，hypertension and LDL-C are risk factors in patients with T2DM and LEDA．