慢性肝病肝硬化患者幽门螺杆菌感染的临床相关性研究  

Relationship between helicobacter pylori infection and chronic liver diseases

作　　者：焦建中[1] 甄英丽[2] 李晓云[1] 葛勤利 杨国嵘[1] 吴群[1] 魏亚君[1] 

机构地区：[1]解放军第一医院,甘肃兰州730030 [2]兰州军区机关门诊部,甘肃兰州730000

出　　处：《甘肃医药》2011年第12期714-717,共4页Gansu Medical Journal

摘　　要：目的:研究慢性肝病肝硬化患者中Hp感染状况以及与肝性脑病、上消化道出血及肝源性溃疡的关联。方法:肝硬化患者406例,采用ELISA法检测HBV-M及抗HCV,PCR法查HBV-DNA和HCV-RNA,金标法查Hp-cagA。14C尿素呼气试验采用HTY1001HP测试仪,如≥0.1dpm/molCo2判定为有Hp活动性感染;血氨采用比色法。胃镜下取胃窦及胃体黏膜组织2块,行HP的组织学涂片检查。选117例HP感染的肝硬化高氨血症患者,分治疗组和对照组。治疗组64例,给予枸缘酸铋钾、克拉霉素及替硝唑进行根除治疗。对照组53例用乳果糖治疗。用PCR法对肝组织进行HpDNA扩增分析。结果:Hp在慢性肝病中的感染率(47.2%)明显高于对照组(24.7%,P<0.01)。Hp阳性组中肝性脑病发生率为36.4%(4/11例),对照组为60.0%(6/10例),对照组肝性脑病的发生率高于治疗组。两组比较具有显著性差异(P<0.05)。进行Hp根除治疗后,治疗组血氨下降明显优于对照组(P<0.05)。Hp阳性组出血率为40.2%(47/117例),阴性组出血率为13.7%(18/131例),两组出血率比较有显著性差异(P<0.05)。非静脉曲张破裂出血Hp阳性率60.5%(26/43例)高于静脉曲张破裂出血的Hp阳性率53.8%(35/65例)。肝源性溃疡组Hp的感染率为60.9%(39/64例)与非肝源性溃疡组比较有显著性差异(P<0.05)。1/23例患者肝组织中扩增出Hp的16SrRNA基因。结论:慢性肝病肝硬化患者中Hp阳性率明显增高;肝性脑病、上消化道出血及肝源性溃疡的发生与Hp感染有关,慢性肝病患者肝组织存在Hp感染。慢性肝病并有Hp感染的患者根除治疗对预防和治疗慢性肝病及其并发症有重要的临床意义。Objective： To study the relationship of helicobacter pylori（HP） infection between hepatic encephalopathy, upper gastrointestinal hemorrhage and hepatogenic ulcer（ HU ） in patients with chronic liver ailment. Methods： In 406 patients with chronic liver ailment, HBV-M and HCV was detected by ELISA; HBV-DNA and HCV-RNA were detected by PCR,and HP-cagA was detected by gold standard method, 14↑C urea breath test was detected by HTY1001 HP in which 14↑C urea breath test ≥0.1dpm/mol Co2 was assessed HP active infection. Blood ammonia value was detected by colorimetric technique. Histological smears of HP was carried ou by taking 2 blocks mucous membrane of gastric antrum and stomach body. Hyperammonemia patients in 117 HP infection of the liver were divided into treatment group（64 cases） and control group （53 cases）. Treatment group was given bismuth potassium citrate, clarithromycin and tinidazole, and control group was given lactulose in which hepatic tissue was performed Hp DNA amplification analysis by PCR Results： The increased rate of Hp infection was significandy higher（47.2%） than that in control group（24.7% ,P〈0.01）. Incidence rate of hepatic encephalopathy in Hp positive group was 36.4% （4/11 case）and in control group was 60.0% （6/10 caes）. Incidence rate of hepatic encephalopathy in eontron group was higher than that in treatment group in ＇which there was significant difference（P〈0.05） in two groups. Blood ammonia value was obviously lower in treatment group than control group after Hp eradication therapy.The rate of hemorrhage of upper digestive tract in HP postive grop was significantly higher （40.2%,47/117 case） than that in HP negative group （13.7%, 18/131 case） in which there was significant difference （P 〈0.05） in two groups. In patients with HU, the incidence of HP was 60.5%（26/43 case） in HP positive rate group and non HU was 53.8%（35/65 case）. The rate of Hp infection was 60.9%（39/64 case） in liver ulcersin group which wa

关 键 词：幽门螺杆菌感染 肝硬化 肝性脑病 上消化道出血 肝源性溃疡 

分 类 号：R512.6[医药卫生—内科学]