幽门螺杆菌阴性消化性溃疡与出血关系的多中心对照研究  

Helicobacter pylori negative peptic ulcer and ulcer bleeding：a multi-center case-control study in China mainland

作　　者：刁萍萍[1] 杜奕奇[1] 李兆申[1] 李淑德[1] 舒建昌[2] 陈锡美[3] 周中杰[4] 陆和平[5] 姜慧卿[6] 刘希双[7] 鲁临[8] 杨力[9] 时昭红[10] 刘鹏飞[11] 屠惠明[12] 陈国昌[13] 张志坚[14] 

机构地区：[1]第二军医大学长海医院消化内科,上海200433 [2]广州市红十字会医院消化内科 [3]上海同济大学附属同济医院消化内科 [4]上海市第七人民医院消化内科 [5]上海市浦东新区人民医院消化内科 [6]河北医科大学第二附属医院消化内科 [7]青岛大学医学院附属医院消化内科 [8]山东省临沂市人民医院消化内科 [9]宁夏医学院附属医院消化内科 [10]武汉市第一医院消化内科 [11]江苏省江阴市人民医院消化内科 [12]江苏省无锡市第四人民医院消化内科 [13]江苏省宜兴市人民医院消化内科 [14]南京军区福州总医院消化内科

出　　处：《中华消化内镜杂志》2010年第8期410-414,共5页Chinese Journal of Digestive Endoscopy

摘　　要：目的明确中国大陆地区幽门螺杆菌（Hp）阴性消化性溃疡与出血的关系。方法拟定于2006年4月至2007年3月期间在国内14个研究中心中进行，每个中心预期调查30例经急诊内镜诊断为胃溃疡和（或）十二指肠溃疡合并出血的患者（PUB组），同时调查30例不伴出血的胃溃疡和（或）十二指肠溃疡患者作为对照（PU组）。共拟人选840例患者，消化性溃疡合并及不合并出血组各420例。在内镜检查中采用快速尿素酶试验和病理检测却感染，并对初次检查却阴性者于1个月后进行尿素呼气试验复查。结果共617例患者纳入分析，其中PUB组263例、PU组354例，2组在性别比、平均年龄等一般状况方面差异无统计学意义（P均〉0．05）。PUB组却阳性率61．2％（161／263）显著低于PU组的87．9％（311／354）（P〈0．001）；PUB组跏阳性的溃疡出血发生复合溃疡的比例7．5％（12／161）显著高于Hp阴性溃疡出血者1．0％（1／102）（P=0．018），但两者在平均发病年龄、性别比、呕血发生率、十二指肠球部溃疡发生率、胃溃疡发生率及溃疡平均直径方面差异无统计学意义（P均〉0．05）。对于初次tip阴性的溃疡出血患者，1个月后的呼气试验复查未发现阳性病例。结论目前中国大陆缉，阴性溃疡在消化性溃疡出血中的比例较高，坳阴性溃疡可能更容易并发消化道出血，需要引起消化专科医生的重视。Objective The primary aim of this study was to examine the proportion and natural history of Helicobacter pylori （lip） negative bleeding peptic ulcers. Methods The study was designed as a multiple-center, case-control study conducted in 14 endoscopy centers in China from April 2006 to March 2007. Each center was expected to recruit 30 peptic ulcer patients with bleeding （PUB group） and 30 with- out （PU group）. All screened patients with upper gastrointestinal bleeding received endoscopy within 24 hours of admission. Biopsy specimens were taken from the antrum to determine Hp infection by rapid urease test and pathology. Patients with negative Hp infection at first examination were asked to receive urease breathe test （UBT） one month later. Results A total of 617 patients were enrolled with 263 in PUB group and 354 in PU group. There is no significant difference in demographic characters between 2 groups （ P 〉 0. 05）. The rate of Hp infection in PUB group （161/263, 61.2% ） was significantly lower than that in PU group （311/354, 87.9%, P 〈 0. 001 ）. The incidence of complex ulcer in Hp positive PUB patients was 7.5% （ 12/161 ）, which is significantly higher than that in Hp negative PUB patients （ 1/102, 1.0%, P = 0. 018）. In PUB group, no significant differences were found between Hp positive and negative patients in regarding of age, sex, rates of haematemesis, duodenal ulcer and gastric ulcer, and size of ulcer （P 〉 0. 05 ）. Among 102 Hp negative cases in PUB, no positive case was found in UBT one month later. Condu- siort We have demonstrated a rise in the incidence of Hp negative bleeding ulcers in China. The idiopathic ulcer was not rare, and might have a higher tendency to cause bleed.

关 键 词：出血 消化性溃疡 幽门螺杆菌 

分 类 号：R573.1[医药卫生—消化系统]