非甾体抗炎药和幽门螺杆菌感染与消化性溃疡发病的关系

目的 探讨服用非甾体抗炎药(NSAIDs)、幽门螺杆菌(Hp)感染与消化性溃疡之间的关系.方法 2008年1月至2010年1月在新疆医科大学第一临床医学院消化内科住院的消化性溃疡患者152例,均行内镜确诊(除外复合溃疡),并行病理学检查排除胃癌.依据溃疡病因将患者分为3组:单纯HP感染组、单纯服用NSAIDs组、Hp感染合并服用NSAIDs组.结果 入选患者152例,男106例,女46例,年龄13～88(51±18)岁.其中单纯Hp感染组93例、单纯服用NSAIDs组41例、Hp感染合并服用NSAIDs组18例,单纯Hp感染组患者年龄明显低于其他2组(P=0.000).服用NSAIDs所治疗的疾病包括:心脑血管疾病,如脑梗死、冠心病、偏头痛等,共33例,占55.9％；骨关节疾病,如类风湿性关节炎、骨性关节病,共13例,占22.0％；其他,如发热、牙痛、痛经等共13例,占22.0％.单纯服用NSMDs组对溃疡并发出血危险性比其他2组高( OR =5.623,95％ CI2.446～12.924,P=0.000),单纯Hp感染或合并服用NSAIDs并未增加溃疡并发出血的危险性(OR=0.223,95％ CI0.110～0.451:OR=1.327,95％ CI0.493～3.569).Hp感染合并服用NSAIDs组溃疡发生的时间(1.7±2.6)个月比单纯服用NSAIDs组的时间(4.5±5.3)个月早(P=0.010).结论 单纯Hp感染或合并服用NSAIDs并未增加溃疡并发出血的危险性,Hp感染合并服用NSAIDs组溃疡发生的时间比单纯服用NSAIDs组的时间早,表明在消化性溃疡的发生上它们之间存在协同性.

Analysis on the association of non-steroidal anti-inflammatory drugs and Helicobacter pylori in peptic ulcer

Objective To analyze the association between non-steroidal anti-inflammatory drugs (NSAIDs)and Helicobacter pylori ( H.pylori) in peptic ulcer.Methods All peptic ulcers (PU) inpatients were diagnosed by endoscopy in our hospital from January 2008 to January 2010 were collected(except complex ulcer).Gastric carcinoma was excluded by pathologic examination.Patients were divided into three groups according to ulcer etiology:H.pylori infection ( group 1 ) ; NSAID use ( group 2) ; and combined H.pylori infection and NSAID use ( group 3).Results Of the 152 PU cases,including 106 male and 46 female patients.The mean age was 51.25 ± 17.84years,Ninety-three patients had ulcers secondary to H.pylori infection,41 secondary to NSAID use and 18 had combined H.pylori and NSAID use.The mean age of patients in group 1 was significantly lower than in the other two groups (P =0.000).Group 2 had a higher risk of bleeding peptic ulcer than the other two groups ( OR 5.623,95％ CI 2.446 ～12.924,P =0.000 ).PU developed earlier in group 3 than in group 2 ( 1.75 ± 2.61 months versus 4.51 ± 5.30months,P=0.010).Conclusions H.pylori infection or the combination of H.pylori infection and NSAID use was not a risk factor for Bleeding peptic ulcer,The development of PU was observed earlier in the combination of H.pylori infection and NSAID use group than in patients with only NSAID use.This suggests a synergic effect between the two risks factors in the development of PU.