幽门螺杆菌感染在应用阿司匹林ASCVD一级预防的社区高血压患者中的现状分析

张吉; 张晨莉; 陈明; 任佳慧; 姚碧莲; 王贞贞; 陈英; 陆玮

doi:10.16766/j.cnki.issn.1674-4152.002991

幽门螺杆菌感染在应用阿司匹林ASCVD一级预防的社区高血压患者中的现状分析

doi: 10.16766/j.cnki.issn.1674-4152.002991

张吉¹,
张晨莉^1, ,,
陈明¹,
任佳慧²,
姚碧莲¹,
王贞贞¹,
陈英¹,
陆玮¹

1.
上海交通大学医学院附属瑞金医院全科医学科，上海 200025
2.
上海市黄浦区打浦桥街道社区卫生服务中心，上海 200023

基金项目:

上海市卫生健康委员会科研课题(面上) 200940005

详细信息

通讯作者:
张晨莉, E-mail: zcl10678@rjh.com.cn

中图分类号: R544.1
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- 文章访问数: 160
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- 被引次数: 0
出版历程
- 收稿日期: 2022-03-11

HP infection in community patients with hypertension treated with aspirin for ASCVD primary prevention

1.
Department of General Practice, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China

摘要

摘要: 目的调查并分析幽门螺杆菌感染在应用阿司匹林动脉粥样硬化性心血管疾病(ASCVD)一级预防的社区高血压患者中的现状。方法选取2020年1月—2021年6月在打浦桥社区内符合ASCVD一级预防、并已长期服用小剂量阿司匹林的高血压患者100例，调查服药前幽门螺杆菌感染及根除情况；进行幽门螺杆菌检测，根据结果进行分组(Hp阳性组和Hp阴性组)；筛选动脉硬化相关指标，对2组进行检测记录及统计学分析。结果所有入选者中在服用阿司匹林前曾行Hp筛查者共13例(占总例数的13.00%)；通过筛查发现Hp阳性者7例，Hp感染率占筛查人数的53.85%；Hp阳性的7例均曾行根除治疗，根除成功5例(根除成功率为71.43%)。在服用阿司匹林过程中曾出现不良反应者16例(不良反应率为16.00%)。对所有入选者进行¹³C-UBT呼气试验，根据结果分为Hp阳性组(39例)和Hp阴性组(61例)。Hp阳性组中TC、低密度脂蛋白胆固醇(LDL-C)较Hp阴性组有明显升高(均P < 0.01)；2组间糖代谢指标及BMI比较，差异无统计学意义(均P > 0.05)；Hp阳性组颈动脉内膜-中层厚度较Hp阴性组明显增厚(P < 0.01)。结论在应用阿司匹林ASCVD一级预防的社区高血压患者中，服药前Hp的筛查率及根除率较低。由于Hp感染可能通过影响脂质代谢、增加颈动脉内膜中层厚度，从而促进动脉粥样硬化的发生，同时Hp感染可加重阿司匹林的消化道损伤，因此建议在服药前行Hp的筛查并根除。
- Hp感染 /
- 阿司匹林 /
- 动脉粥样硬化性心血管疾病一级预防
Abstract: Objective This study aims to investigate and analyse the current situation of Helicobacter pylori (Hp) infection in community patients with hypertension treated with aspirin for ASCVD primary prevention. Methods A total of 100 hypertensive patients who were eligible for ASCVD primary prevention and had been taking low-dose aspirin for a long time in Dapuqiao Community from January 2020 to June 2021 were selected to investigate the previous histories of Helicobacter pylori infection and eradication before taking the medication. Helicobacter pylori testing was performed and grouped according to the results(Hp-positive and Hp-negative groups); atherosclerosis-related indexes were screened, and the test of the two groups were recorded and statistically analysed. Results Amongst the selected patients, 13 (13.00%) had been screened for Hp before taking aspirin; 7 cases were found to be infected with Hp through screening, and the Hp infection rate accounted for 53.85% of the screening population. All 7 cases with Hp infection had undergone eradication therapy, and 5 cases were successfully eradicated (the eradication success rate was 71.43%). In addition, 16 cases showed adverse reactions in the course of taking aspirin (the adverse reaction rate was 16.00%). All the selected cases underwent ¹³C-UBT breath test, and they were divided into the Hp-positive group (n=39) and Hp-negative group (n=61) based on the results. TC, TG and LDL-C in the Hp-positive group were significantly higher than those in the Hp-negative group (all P < 0.01). The comparison of the HOMA-IR index and BMI, which reflecting insulin resistance, between the two groups showed statistically significant differences (both P > 0.05). Carotid intima-media thickness (CIMT) in the Hp-positive group was significantly thicker than that in the Hp-negative group (P < 0.01). Conclusion The screening rate and eradication rate of Hp are low in community patients with hypertension treated with aspirin for ASCVD primary prevention. Hp infection may promote atherosclerosis by affecting glucose and lipid metabolism, increasing insulin resistance and increasing carotid intima-media thickness. Furthermore, Hp infection can aggravate the gastrointestinal damage from aspirin. Therefore, Hp should be screened and eradicated before taking medicine.
- Helicobacter pylori infection /
- Aspirin /
- ASCVD primary prevention
利益冲突 无

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表 1 Hp感染与阿司匹林不良反应发生率

Table 1. Hp infection and incidence of adversereactions to aspirin

主要症状	Hp阳性组(例)	Hp阴性组(例)	总发生[例(%)]
腹胀	4	3	7(43.75)
腹痛	2	1	3(18.75)
黑便	2	0	2(12.50)
皮肤瘀斑	0	2	2(12.50)
牙龈出血	1	0	1(6.25)
球结膜出血	0	1	1(6.25)
合计	9	7	16(100.00)

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表 2 Hp感染与糖脂代谢各项指标的关系[M(P₂₅, P₇₅)]

Table 2. Relationship between Hp infection and various indexes of glucose and lipid metabolism[M(P₂₅, P₇₅)]

组别	例数	TC(mmol/L)	TG(mmol/L)	LDL-C(mmol/L)	HDL-C(mmol/L)	BMI
Hp阳性组	39	5.68(5.10, 6.21)	1.50(1.19, 1.84)	3.83(3.34, 4.33)	1.18(0.92, 1.40)	26.22(23.83, 28.45)
Hp阴性组	61	4.16(3.47, 4.71)	1.52(1.10, 1.71)	2.60(1.81, 3.01)	1.19(1.06, 1.33)	25.25(23.99, 26.70)
Z值		-5.373	-0.545	-5.429	-0.363	-1.954
P值		< 0.001	0.586	< 0.001	0.717	0.051

组别	例数	FPG(mmol/L)	FIN(mIU/L)	HbA1C(%)	HOMA-IR	HOMA-β(%)
Hp阳性组	39	5.12(4.67, 7.10)	11.60(6.60, 16.46)	5.60(5.40，5.90)	2.53(1.41, 5.57)	109.09(70.94, 172.84)
Hp阴性组	61	5.25(4.79, 5.78)	10.66(6.15, 13.08)	5.80(5.70，6.00)	2.69(1.41, 3.16)	115.51(68.19, 192.24)
Z值		-1.400	-7.810	-1.620	-1.545	-2.223
P值		0.889	0.435	0.105	0.122	0.823

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表 3 Hp感染与CIMT的关系[M(P₂₅, P₇₅)，mm]

Table 3. Relationship between Hp infection and CIMT[M(P₂₅, P₇₅), mm]

组别	例数	R-CIMT	L-CIMT
Hp阳性组	39	0.70(0.70，0.70)	0.70(0.70，0.70)
Hp阴性组	61	0.60(0.60，0.70)	0.60(0.60，0.70)
Z值		-4.181	-4.081
P值		< 0.001	< 0.001

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