Investigation and Risk Factors of Helicobacter pylori Infection in Patients with Inflammatory Bowel Disease
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摘要:
目的 探究炎症性肠病(inflammatory bowel disease,IBD)患者幽门螺杆菌(Helicobacter pylori, Hp)感染现况,并初步分析其发生Hp感染的危险因素。 方法 2020年1月1日—2020年12月31日通过发送电子问卷的方式对北京协和医院长期随访IBD患者及年龄、性别与之相匹配的北京社区居民展开调查。收集两组人群一般资料、Hp感染相关信息、环境因素等资料。比较两组人群Hp阳性率差异并分析IBD患者Hp感染相关危险因素。 结果 经倾向性评分匹配后,最终纳入本研究IBD患者122例、社区居民1739例。两组人群倾向性评分直方图高度一致。IBD患者Hp阳性率显著低于社区居民(13.1%比42.7%,P<0.001),且两组Hp阳性率均随年龄增高呈逐渐升高趋势,但组内比较差异均无统计学意义(P均>0.05)。单因素分析显示,IBD患者中Hp阳性者长期共餐者Hp感染的比例显著高于Hp阴性者(43.8% 比18.9%,P=0.006)。 结论 IBD患者Hp感染率较社区居民降低,其发生Hp感染可能与长期共餐者Hp阳性有关。 Abstract:Objective To investigate the rate and risk factors of Helicobacter pylori(Hp) infection in patients with inflammatory bowel disease(IBD). Methods A survey was conducted from January 1, 2020 to December 31, 2020 by sending an electronic questionnaire to long-term follow-up IBD patients of Peking Union Medical College Hospital and age-sex-matched Beijing community residents. General information, information related to Hp infection and environmental factors were collected from the two groups. The differences in Hp positivity rates between the two groups and IBD patients with different clinical profiles were compared. Results After propensity score matching, 122 patients with IBD and 1739 community residents were finally included in this study. The histograms of propensity score values were highly consistent between the two groups. The ratio of Hp infection was significantly lower in IBD patients than in the community residents (13.1% vs. 42.7%, P < 0.001). The ratio of Hp infection in both groups increased with age but showed no statistical significance (all P > 0.05). Univariate analysis showed that the IBD patients with Hp positive co-diners had a significantly higher ratio of Hp infection than those with Hp negative co-diners (43.8% vs. 18.9%, P=0.006). Conclusions The Hp infection rate was lower in IBD patients than in community residents. The possible risk factor may be co-dining with Hp positives. -
Key words:
- inflammatory bowel disease /
- Helicobacter pylori infection /
- risk factors
作者贡献:周如宁负责问卷发放与回收、数据分析、论文撰写;阮戈冲、马凯宇、鲍秀琦、王维国、张莉负责问卷制作、研究对象招募;杨红、阮戈冲负责研究总体设计、论文审校。利益冲突:所有作者均声明不存在利益冲突 -
图 1 两组人群匹配前后倾向性评分直方图
A. IBD患者匹配前;B.社区居民匹配前;C. IBD患者匹配后;D.社区居民匹配后
IBD:同表 1图 2 不同年龄段IBD患者及社区居民Hp阳性率比较
A.社会居民;B.IBD患者
IBD:同表 1;Hp:幽门螺杆菌表 1 倾向性评分匹配后IBD患者与社区居民基线资料比较
指标 IBD患者(n=122) 社区居民(n=1739) P值 年龄[M(P25, P75),岁] 40(31, 51) 45(34, 54) 0.055 性别[n(%)] 0.109 男 76(62.3) 949(54.6) 女 46(37.7) 790(45.4) BMI[n(%)] <0.001 <18.5 kg/m2 27(22.1)* 73(4.2) 18.5~<24.0 kg/m2 63(51.6) 659(37.9) 24.0~<28.0 kg/m2 25(20.5) 650(37.4) ≥28.0 kg/m2 7(5.7)* 357(20.5) 吸烟史[n(%)] <0.001 目前吸烟 11(9.0)* 482(27.7) 曾吸烟(已戒) 25(20.5)* 87(5.0) 无 86(70.5) 1170(67.3) 饮酒史[n(%)] >0.999 规律饮酒 14(11.5) 197(11.3) 无规律饮酒 108(88.5) 1542(88.7) 体力劳动强度[n(%)] <0.001 轻度 79(64.8)* 505(29.0) 中度 28(23.0)* 674(38.8) 重度 10(8.2)* 502(28.9) 极重度 5(4.1) 58(3.3) 家庭人均月收入[n(%)] 0.456 <1000元 2(1.6) 28(1.6) 1000~5000元 42(34.4) 694(39.9) >5000元 41(33.6) 472(27.1) 不详 37(30.3) 545(31.3) 婚姻状况[n(%)] 0.076 未婚 31(25.4) 288(16.6) 已婚 89(73.0) 1414(81.3) 丧偶 0(0) 11(0.6) 离婚 2(1.6) 26(1.5) 家庭人口[n(%)] 0.365 1人 5(4.1) 38(2.2) 2~3人 80(65.6) 1194(68.7) ≥4人 37(30.3) 507(29.2) IBD:炎症性肠病;BMI:体质量指数;*组间比较存在统计学差异 表 2 Hp阳性与Hp阴性IBD患者临床资料比较
指标 Hp阳性(n=16) Hp阴性(n=106) P值 年龄[M(P25, P75),岁] 43(38, 58) 40(29, 50) 0.110 性别[n(%)] 0.165 男 7(43.8) 69(65.1) 女 9(56.3) 37(34.9) BMI[n(%)] 0.878 <18.5 kg/m2 4(25.0) 23(21.7) 18.5~<24.0 kg/m2 9(56.3) 54(50.9) 24.0~<28.0 kg/m2 2(12.5) 23(21.7) ≥28.0 kg/m2 1(6.3) 6(5.7) IBD疾病类型[n(%)] 0.602 溃疡性结肠炎 10(62.5) 52(49.1) 克罗恩病 5(31.3) 44(41.5) 疾病类型待定 1(6.3) 10(9.4) 婚姻状况[n(%)] 0.423 未婚 2(12.5) 29(27.4) 已婚 14(87.5) 75(70.8) 丧偶 0(0) 0(0) 离婚 0(0) 2(1.9) 家庭人均月收入[n(%)] 0.398 <1000元 1(6.2) 1(0.9) 1000~5000元 7(43.8) 35(33.0) >5000元 5(31.2) 36(40.0) 不详 3(18.8) 34(32.1) 体力劳动强度[n(%)] 0.283 轻度 9(56.3) 70(66.0) 中度 3(18.8) 25(23.6) 重度 3(18.8) 7(6.6) 极重度 1(6.3) 4(3.8) 饮用水来源[n(%)]† 0.505 自来水 6(37.5) 24(22.9) 白开水 6(37.5) 36(34.3) 桶装水/公共饮用水 4(25.0) 38(36.2) 瓶装水 0(0) 7(6.7) 长期共餐者Hp感染[n(%)] 0.006 是 7(43.8)* 20(18.9) 否 0(0)* 32(30.2) 不详 9(56.3) 54(50.9) 家庭人口[n(%)] 0.199 1人 1(6.3) 4(3.8) 2~3人 13(81.3) 67(63.2) ≥4人 2(12.5) 35(33.0) 吸烟史[n(%)] 0.411 目前吸烟 0(0) 11(10.4) 曾吸烟(已戒) 2(12.5) 23(21.7) 无 14(87.5) 72(67.9) 饮酒史[n(%)] >0.999 规律饮酒 2(12.5) 12(11.3) 无规律饮酒 14(87.5) 94(88.7) IBD、BMI:同表 1;Hp:同图 2; *组间比较存在统计学差异;†Hp阴性患者存在1例缺失 -
[1] Yang H, Zhou R, Bai X, et al. Trend and Geographic Variation in Incidence and Prevalence of Inflammatory Bowel Disease in Regions Across China: A Nationwide Employee Study Between 2013 and 2016[J]. Front Med (Lausanne), 2022, 9: 900251. [2] Chang JT. Pathophysiology of Inflammatory Bowel Diseases[J]. N Engl J Med, 2020, 383: 2652-2664. doi: 10.1056/NEJMra2002697 [3] Piovani D, Danese S, Peyrin-Biroulet L, et al. Environ-mental Risk Factors for Inflammatory Bowel Diseases: An Umbrella Review of Meta-analyses[J]. Gastroenterology, 2019, 157: 647-659 e4. doi: 10.1053/j.gastro.2019.04.016 [4] Ren S, Cai P, Liu Y, et al. Prevalence of Helicobacter pylori infection in China: A systematic review and meta-analysis[J]. J Gastroenterol Hepatol, 2022, 37: 464-470. doi: 10.1111/jgh.15751 [5] Wu XW, Ji HZ, Yang MF, et al. Helicobacter pylori infection and inflammatory bowel disease in Asians: a meta-analysis[J]. World J Gastroenterol, 2015, 21: 4750-4756. doi: 10.3748/wjg.v21.i15.4750 [6] Yu Y, Zhu S, Li P, et al. Helicobacter pylori infection and inflammatory bowel disease: a crosstalk between upper and lower digestive tract[J]. Cell Death Dis, 2018, 9: 961. doi: 10.1038/s41419-018-0982-2 [7] Kienesberger S, Cox LM, Livanos A, et al. Gastric Helicobacter pylori Infection Affects Local and Distant Microbial Populations and Host Responses[J]. Cell Rep, 2016, 14: 1395-1407. doi: 10.1016/j.celrep.2016.01.017 [8] Luther J, Owyang SY, Takeuchi T, et al. Helicobacter pylori DNA decreases pro-inflammatory cytokine production by dendritic cells and attenuates dextran sodium sulphate-induced colitis[J]. Gut, 2011, 60: 1479-1486. doi: 10.1136/gut.2010.220087 [9] 吴开春, 梁洁, 冉志华, 等. 炎症性肠病诊断与治疗的共识意见(2018年·北京)[J]. 中国实用内科杂志, 2018, 38: 796-813. https://www.cnki.com.cn/Article/CJFDTOTAL-SYNK201809007.htm [10] 国家消化系疾病临床医学研究中心, 中华医学会消化病学分会幽门螺杆菌和消化性溃疡学组, 全国幽门螺杆菌研究协作组. 中国居民家庭幽门螺杆菌感染的防控和管理专家共识(2021年)[J]. 中华消化杂志, 2021, 41: 221-233. doi: 10.3760/cma.j.cn311367-20210219-00108 [11] 国家技术监督局. GB3869-1997《体力劳动强度分级》[EB/OL]. (1997-07-07)[2022-11-09]. https://max.book118.com/html/2018/1224/5324311100001342.shtm. [12] el-Omar E, Penman I, Cruikshank G, et al. Low preval-ence of Helicobacter pylori in inflammatory bowel disease: association with sulphasalazine[J]. Gut, 1994, 35: 1385-1388. doi: 10.1136/gut.35.10.1385 [13] Ding ZH, Xu XP, Wang TR, et al. The prevalence of Helicobacter pylori infection in inflammatory bowel disease in China: A case-control study[J]. PLoS One, 2021, 16: e0248427. doi: 10.1371/journal.pone.0248427 [14] Castano-Rodriguez N, Kaakoush NO, Lee WS, et al. Dual role of Helicobacter and Campylobacter species in IBD: a systematic review and meta-analysis[J]. Gut, 2017, 66: 235-249. doi: 10.1136/gutjnl-2015-310545 [15] Song MJ, Park DI, Hwang SJ, et al. The prevalence of Helicobacter pylori infection in Korean patients with inflam-matory bowel disease, a multicenter study[J]. Korean J Gastroenterol, 2009, 53: 341-347. doi: 10.4166/kjg.2009.53.6.341 [16] Abd El-Wahab EW, Youssef EI, Hassouna E. Helicobacter pylori infection in patients with inflammatory bowel diseases: a single-centre, prospective, observational study in Egypt[J]. BMJ Open, 2022, 12: e057214. doi: 10.1136/bmjopen-2021-057214 [17] Bartels LE, Jepsen P, Christensen LA, et al. Diagnosis of Helicobacter Pylori Infection is Associated with Lower Prevalence and Subsequent Incidence of Crohn's Disease[J]. J Crohns Colitis, 2016, 10: 443-448. doi: 10.1093/ecco-jcc/jjv229 [18] Lin KD, Chiu GF, Waljee AK, et al. Effects of Anti-Helicobacter pylori Therapy on Incidence of Autoimmune Diseases, Including Inflammatory Bowel Diseases[J]. Clin Gastroenterol Hepatol, 2019, 17: 1991-1999. doi: 10.1016/j.cgh.2018.12.014 [19] Zhong Y, Zhang Z, Lin Y, et al. The Relationship Between Helicobacter pylori and Inflammatory Bowel Disease[J]. Arch Iran Med, 2021, 24: 317-325. doi: 10.34172/aim.2021.44 [20] Li X, Tan J, Zhang F, et al. H. pylori Infection Alleviates Acute and Chronic Colitis with the Expansion of Regulatory B Cells in Mice[J]. Inflammation, 2019, 42: 1611-1621. doi: 10.1007/s10753-019-01022-0 [21] Zhang H, Dai Y, Liu Y, et al. Helicobacter pylori Colonization Protects Against Chronic Experimental Colitis by Regulating Th17/Treg Balance[J]. Inflamm Bowel Dis, 2018, 24: 1481-1492. [22] Yang F, Xu YL, Zhu RF. Helicobacter pylori infection and the risk of colorectal carcinoma: a systematic review and meta-analysis[J]. Minerva Med, 2019. 110: 464-470. [23] Bai X, Jiang L, Ruan G, et al. Helicobacter pylori may participate in the development of inflammatory bowel disease by modulating the intestinal microbiota[J]. Chin Med J (Engl), 2022, 135: 634-638.