萎缩性与非萎缩性胃炎患者之间幽门螺杆菌根除率的差异性研究

杜梅玲; 楚艳; 张自强; 温朝阳; 陶怡然

doi:10.16766/j.cnki.issn.1674-4152.003015

萎缩性与非萎缩性胃炎患者之间幽门螺杆菌根除率的差异性研究

doi: 10.16766/j.cnki.issn.1674-4152.003015

1.
复旦大学附属上海市第五人民医院消化内科，上海 200240
2.
复旦大学附属华山医院胃肠外科，上海 201907
3.
上海市周浦社区卫生服务中心，上海 201318

基金项目:

国家自然科学基金项目 82002020

详细信息

通讯作者:
陶怡然，E-mail: tyr416722@163.com

中图分类号: R573.3
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出版历程
- 收稿日期: 2023-03-26
- 网络出版日期: 2023-08-26

Difference of Helicobacter pylori eradication rate between patients with atrophic gastritis and non-atrophic gastritis

1.
Department of Gastroenterology, Fudan University Affiliated Shanghai Fifth People' s Hospital, Shanghai 200240, China

摘要

摘要: 目的探究萎缩性与非萎缩性胃炎患者中幽门螺杆菌(Hp)根除率的差异以及胃窦黏膜萎缩、肠化生和Hp密度分级是否影响Hp根除结果。方法纳入2021年1—12月在上海市第五人民医院消化内科门诊接受阿莫西林联合克拉霉素治疗的505例Hp阳性初治患者，根据内镜下的组织病理学结果分为萎缩性胃炎和非萎缩性胃炎2组。采用倾向性评分匹配(PSM)平衡组间人口学变量后比较组间Hp根除失败率，并进行logistic回归分析。结果 PSM后萎缩性胃炎组患者的Hp根除失败率显著高于非萎缩性胃炎组(16.3% vs. 7.8%，P=0.023)，这种差异在男性中显著(21.2% vs. 7.1%，P=0.008)，在女性中不显著(P＞0.05)。通过logistic回归分析发现，Hp根除失败与胃窦黏膜轻度(病理分级+)萎缩/肠化生呈正相关性(OR=2.614，95% CI：1.227~5.571，P=0.013；OR=2.882，95% CI：1.310~6.338，P=0.009)，而与中重度(病理分级++~+++)萎缩/肠化生无关(均P>0.05)。此外，Hp根除失败与胃窦黏膜Hp密度分级无关(P＞0.05)。结论萎缩性胃炎患者的Hp根除失败率显著高于非萎缩性胃炎患者，这种差异在男性中显著而在女性中不显著；Hp根除失败只与轻度胃窦黏膜萎缩/肠化生有关而与中重度萎缩/肠化生无关；Hp根除失败与胃窦黏膜Hp密度分级无关。
- 萎缩性胃炎 /
- 幽门螺杆菌 /
- 阿莫西林 /
- 克拉霉素 /
- 倾向性评分匹配
Abstract: Objective To investigate the difference of Helicobacter pylori (Hp) eradication rate between patients with atrophic gastritis and non-atrophic gastritis, and to analyze the relationship of the degree of gastric antrum atrophy, intestinal metaplasia and Hp density with Hp eradication rate. Methods A total of 505 Hp-positive patients who initially received amoxicillin combined with clarithromycin regimen in Fudan University Affiliated Shanghai Fifth People' s Hospital from January to December 2021 were enrolled and divided into two groups on the basis of pathological features in endoscopy, namely atrophic gastritis and non-atrophic gastritis. Propensity score matching (PSM) was used to reduce bias in the comparison of Hp eradication rates between two groups, followed by logistic regression analysis. Results After PSM, the failure rate of Hp eradication in atrophic gastritis group was significantly higher than that in non-atrophic gastritis group (16.3% vs. 7.8%, P=0.023), and the difference was significant in male (21.2% vs. 7.1%, P=0.008), but not in female (P > 0.05). Logistic regression analysis showed that the failure rate of Hp eradication was positively correlated with mild (pathological grade +) antral atrophy/intestinal metaplasia (OR=2.614, 95% CI: 1.227-5.571, P=0.013; OR=2.882, 95% CI: 1.310-6.338, P=0.009), but not associated with moderate to severe (pathological grade ++ to +++) antral atrophy/intestinal metaplasia (all P > 0.05). Moreover, Hp eradication failure was independent of antral Hp density (P > 0.05). Conclusion The failure rate of Hp eradication in patients with atrophic gastritis is significantly higher than that in patients with non-atrophic gastritis, and the difference is significant in males but not in females. In addition, Hp eradication failure increases only in patients with mild antral atrophy/intestinal metaplasia and doesn' t increase with the severity of antral atrophy/intestinal metaplasia. Moreover, Hp eradication failure is independent of antral Hp density.
- Atrophic gastritis /
- Helicobacter pylori /
- Amoxicillin /
- Clarithromycin /
- Propensity score matching

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表 1 萎缩性与非萎缩性胃炎患者人口学、病理学特征和Hp根除结果的比较

Table 1. Comparison of demographic, pathological features and Hp eradication results in patients with atrophic and nonatrophic gastritis

组别	例数	年龄(x±s，岁)	性别(例)		萎缩分级[例(%)]			肠化生分级[例(%)]			Hp密度分级[例(%)]			Hp根除结果[例(%)]
组别	例数	年龄(x±s，岁)	男性	女性	0	+	++~+++	0	+	++~+++	0	+	++~+++	成功	失败
萎缩性胃炎	153	53.21±11.79	85	68	0	115(75.2)	38(24.8)	4(2.6)	111(72.5)	38(24.8)	16(10.4)	76(49.7)	61(39.9)	128(83.7)	25(16.3)
非萎缩性胃炎	352	43.99±12.10	162	190	352(100.0)	0	0	332(94.3)	20(5.7)	0	17(4.8)	178(50.6)	157(44.6)	317(90.1)	35(9.9)
统计量		-8.010^a	3.878^b		-22.179^c			-20.066^c			-0.729^c			4.168^b
P值		＜0.001	0.049		＜0.001			＜0.001			0.466			0.041
注：^a为t值，^b为χ²值，^c为Z值。

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表 2 PSM之后2组患者间人口学特征及Hp根除结果的比较

Table 2. Comparison of demographic characteristics and Hp eradication results between 2 groups after PSM

组别	例数	年龄(x±s，岁)	性别(男/女，例)	Hp根除结果[例(%)]
组别	例数	年龄(x±s，岁)	性别(男/女，例)	成功	失败
萎缩性胃炎	153	53.21±11.79	85/68	128(83.7)	25(16.3)
非萎缩性胃炎	153	52.27±10.76	80/73	141(92.2)	12(7.8)
统计量		-0.724^a	0.329^b	5.200^b
P值		0.469	0.566	0.023
注：^a为t值，^b为χ²值。

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表 3 男性患者中2组之间年龄和Hp根除结果的比较

Table 3. Comparison of age and Hp eradication outcomes between 2 groups in male patients

组别	例数	年龄(x±s，岁)	Hp根除结果[例(%)]
组别	例数	年龄(x±s，岁)	成功	失败
萎缩性胃炎	85	52.53±11.86	67(78.8)	18(21.2)
非萎缩性胃炎	162	46.35±11.65	148(91.4)	14(8.6)
统计量		-3.916^a	7.767^b
P值		＜0.001	0.005
注：^a为t值，^b为χ²值。

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表 4 女性患者中2组之间年龄和Hp根除结果的比较

Table 4. Comparison of age and Hp eradication outcomes between 2 groups in female patients

组别	例数	年龄(x±s，岁)	Hp根除结果[例(%)]
组别	例数	年龄(x±s，岁)	成功	失败
萎缩性胃炎	68	54.06±11.73	61(89.7)	7(10.3)
非萎缩性胃炎	190	41.98±12.14	169(88.9)	21(11.1)
统计量		-7.218^a	0.030^b
P值		＜0.001	0.863
注：^a为t值，^b为χ²值。

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表 5 PSM后男性患者中2组之间年龄和Hp根除结果的比较

Table 5. Comparison of age and Hp eradication outcomes between 2 groups in male patients after PSM

组别	例数	年龄(x±s，岁)	Hp根除结果[例(%)]
组别	例数	年龄(x±s，岁)	成功	失败
萎缩性胃炎	85	52.53±11.86	67(78.8)	18(21.2)
非萎缩性胃炎	85	51.91±11.41	79(92.9)	6(7.1)
统计量		-0.349^a	6.986^b
P值		0.727	0.008
注：^a为t值，^b为χ²值。

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表 6 PSM后女性患者中2组之间年龄和Hp根除结果的比较

Table 6. Comparison of age and Hp eradication outcomes between the two groups in female patients after PSM

组别	例数	年龄(x±s，岁)	Hp根除结果[例(%)]
组别	例数	年龄(x±s，岁)	成功	失败
萎缩性胃炎	68	54.06±11.73	61(89.7)	7(10.3)
非萎缩性胃炎	68	52.44±10.05	59(86.8)	9(13.2)
统计量		-0.863^a	0.283^b
P值		0.389	0.595
注：^a为t值，^b为χ²值。

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表 7 胃窦黏膜萎缩、肠化生和Hp密度的病理分级与Hp根除失败的logistic回归分析

Table 7. Logistic regression analysis of pathological grade of antral mucosa atrophy, intestinal metaplasia and Hp density and Hp eradication failure

变量	β	SE	Waldχ²	P值	OR	95% CI
萎缩分级^a
+	0.961	0.386	6.198	0.013	2.614	1.227~5.571
++~+++	0.296	0.612	0.234	0.629	1.344	0.405~4.462
肠化生分级^b
+	1.058	0.402	6.927	0.009	2.882	1.310~6.338
++~+++	0.395	0.625	0.310	0.528	1.484	0.436~5.055
Hp密度分级^c
++~+++	0.543	0.381	2.031	0.154	1.721	0.816~3.629
0	1.198	0.596	4.040	0.044	3.315	1.031~10.662
注：^a萎缩分级以“0级”作为参照；^b肠化生分级以“0级”作为参照；^cHp密度分级以“+级”作为参照。各变量赋值情况如下, Hp根除结果(因变量)，Hp根除失败=1，成功=0；萎缩分级，0级=0，+级=1，++~+++级=2；肠化生分级，0级=0，+级=1，++~+++级=2；Hp密度分级，0级=0，+级=1，++~+++级=2。

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