幽门螺杆菌感染与老年人上消化道疾病关系的临床研究

目的通过长期随访临床观察幽门螺杆菌（Helicobcter pylori,Hp）相关胃炎易继发消化性溃疡和胃癌。Hp感染率有随着年龄增长而升高的趋势,阐明Hp与老人上消化道疾病的关系。方法620例均为门诊和住院患者,按年龄分为老年组≥60岁272例,其中男180例,女92例,中位年龄65岁;青壮年组〈60岁348例,其中男213例,女135例,中位年龄36岁。上消化道疾病诊断：患者在电子胃镜下肉眼观察其胃和十二指肠粘膜,并在病变部位取材活检,送病理检查,以确定疾病性质（诊断）。Hp检测方法：采用^14C尿素呼气试验方法。患者于胃镜检查结束后或在上午空腹时接受试验。结果620例患者中Hp阳性371例,阳性率60%。其中老年组Hp阳性率为66.2%（180/272）,明显高于青壮年的54.9%（191/348）,差异有统计学意义（P〈0.01）。老年组慢性胃炎和胃溃疡Hp阳性率为66.4%及75.6%,均高于青壮年组的43.9%和41.0%,差异有统计学意义（P〈0.01）。老年组胃溃疡及胃癌患病率高于青壮年组差异有统计学意义（P〈0.05或〈0.01）。结论通过研究提示Hp感染在老年慢性胃炎和胃溃疡发病学上,具有比青壮年更大的重要性。同时,支持年龄与Hp成正相关的观点,说明Hp感染与上消化道疾病的发病关系密切。

Clinical Observation of Relation between Helicobacter Pylori infection and Upper Gastrointestinal Tract diseases of aged people

Objective The long-term follow up clinical observation of Helicobacter pylori(H.pylori)-relating gastritis,peptic ulcer and gastric cancer shows that the infection rate of H.pylori intends to rise as aging.The aim of the study was to elucidate the relation between Helicobacter pylori infection and upper gastrointestinal tract diseases.Methods All 620 cases were recruited from either out-patient clinic or hospitalization,272(180 males,92 females)out of which were enrolled into Senior Group(above 60)with an average age of 65;and the other 348(213 males,135 females)were in Midlife Group with an average age of 36.In order to definite the nature of the disease,Gastroduodenal mucous membranes were under macroscopic observation with electronic gastroscope,biopsies and pathology examinations were practised in the diseased region.The status of H.pylori infection was determined by 13C-urea breath test taken after the electronic gastroscopy or on an empty stomach in the morning.Results H.pylori was remained positive in 371 cases(60%).The Senior Group shows an obviously higher positive rate of 66.2%(180/272)than the Midlife Group-54.9%(191/348).The difference was statisticallly significant(P<0.01).Chronic gastritis and gastric ulcer H.pylori positive rates were separately 66.4% and 75.6% in the Senior Group vs.43.9% and 41.0% in the Midlife Group.The difference was statisticallly significant(P<0.01).The attack rates of gastric ulcer and gastric cancer in the Senior Group are both higher than those in the Midlife Group.The difference was statisticallly significant(P<0.05 or <0.01).Conclusions Our results indicate that the H.pylori infection shows a more significant importance to the aged than to the midlife in pathogenesis of Chronic gastritis and gastric ulcer.The results also support the viewpoint that the H.pylori infection rate has a direct proportion with age,and stay in a very close relation to the upper gastrointestinal tract diseases.