不同毒力幽门螺杆菌感染对2型糖尿病患者血糖和胰岛素抵抗的影响

探讨不同毒力菌株的幽门螺杆菌（Helicobacter pylori,Hp）感染对2型糖尿病（T2DM）患者胰岛素抵抗和血糖的影响.选择2012年1月至2013年3月住院的168例T2DM患者,男88例,女80例,病程（5.3±2.2）年,年龄（56±4）岁.采集胃肠道症状,并分别测定胰岛素抵抗指数（HOMA-IR）和糖化血红蛋白（HbA1c）、血脂、肝、肾功能等.应用Ho蛋白芯片检测Ho并进行毒力分型,将患者分为HoⅠ型组、Ⅱ型组和阴性组.各组患者继续降糖治疗的同时,对Ⅰ型组行Ho根除治疗,6个月后再次复查各项指标进行对比.多个样本均数两两比较采用方差分析.结果显示治疗前Ⅰ型组、Ⅱ型组和阴性组患者消化道症状阳性率分别为67.9％、28.9％和11.4％;HbA1c分别是（9.1±0.9）％、（8.2±0.8）％和（7.8±0.8）％;HOMA-IR分别为4.6±1.4、3.9±1.2和3.2±0.9.治疗后,Ⅰ型组消化道症状明显改善,3组的HbA1c分别下降为（7.3±0.8）％、（7.1±0.9）％和（6.9±0.6）％;HOMA-IR分别下降为3.9±1.3、3.4±1.1和3.1±0.8.Ⅰ型组HbA1c、HOMA-IR下降幅度最大,差异较治疗前有统计学意义（均P＜0.05）.表明Hp感染尤其是毒力较强的Ⅰ型Hp感染患者胰岛素抵抗加重,血糖不易控制,应尽快根除治疗.

Impact of different virulent strains of the Helicobacter pylori infection on blood glucose and insulin resistance in patients with type 2 diabetes mellitus

To investigate the impact of different virulent strains of Helicobacterpylori （Hp） infection on the insulin resistance and glucose level in the type 2 diabetes mellitus （T2DM） patients.A total of 168 T2DM inpatients were recruited and gastrointestinal symptoms were collected from January 2012 to March 2013.Blood glucose,insulin levers,glycated hemoglobin A1c （HbA1c）,blood lipids,liver function and kidney function were tested and IR indexs （HOMA-IR） were calculated for all patients.Based on the Hp protein microarray chip test,the patients were divided into type Ⅰ group,type Ⅱ group and negative group.Patients in each group continued hypoglycemic therapy while Hp eradication therapy were executed in type Ⅰ group.All indexs were rechecked 6 months later.Multiple sample mean pairwise comparisons using analysis of variance.Results showed before treatment,the cases of the type Ⅰ group,type Ⅱ group and negative group were 53,45 and 70,respectively.There had no statistical difference of the blood lipids,liver function,kidney function in the 3 groups,and the positive rate of gastrointestinal symptoms was 67.9%,28.9% and 11.4%,respectively; HbA1c were （9.1 ± 0.9）%,（8.2 ± 0.8）% and （7.8 ± 0.8）%,respectively; HOMA-IR were 4.6 ± 1.4,3.9 ± 1.2 and 3.2 ± 0.9,respectively.After eradication therapy for 6 months,gastrointestinal symptoms of type Ⅰ group decreased significantly.The HbA1c in the type Ⅰ group,type Ⅱ group and negative group decreased to （7.3 ± 0.8）%,（7.1 ± 0.9）% and （6.9 ± 0.6）%,respectively; while the HOMA-IR in 3 groups decreased to 3.9± 1.3,3.4± 1.1 and 3.1 ±0.8,respectively.There was largest decline in HbA 1 c,HOMA-IR in type Ⅰ group.Compared with before treatment,the difference was statistically significant（both P〈0.05）.We found that insulin resistance was increased in patients with infected Hp infection,especially with virulent type Ⅰ Hp infection,and which caused poor glycemic control.Treatment should be eradicated as soon as possibl