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目的本文从流行病学角度研究西安地区幽门螺杆菌细胞毒素相关蛋白 A(CagA)阳性 Hp 菌株感染与胃十二指肠溃疡发病的关系.方法采用病例对照研究方法,病例组与对照组的配比比例为1:2.病例组为本院消化科自1997-10/1998-10连续住院的患者,经内镜检查及病理检查证实为活动期胃溃疡和(或)十二指肠溃疡.对照组分为两组,对照1组为同期住院的本科及其他科住院的非胃十二指肠疾病患者,对照2组为同期普查健康人群.病例组与对照组的配比因素为性别、民族、年龄(相差5岁以内).采用问卷调查,内容涉及与胃十二指肠溃疡发病可能有关的32个因素,对所有因素进行量化,应用 SAS 软件进行处理.CagA 阳性 Hp 感染的检测结果分析采用 x~2检验.对所调查因素首先进行1:1及1:2单因素条件 Logistic 回归分析,有显著性意义的因素,计算近似相对危险度(odds ratio,OR)及其95%的可信区间(confidence interval,CI).两因素协同作用采用分层分析方法.对单因素分析时作用较大及调查结果较准确的因素,用多因素条件 Logistic 回归分析.血清中抗 CagA 抗体的检测采用斑点金免疫渗滤法(DIGFA).结果①在胃溃疡组与对照1组及对照2组的配对研究中,胃溃疡组的 CagA 阳性 Hp 感染率显著高于两个对照组,OR 分别为5.0与6.5,P 分别<0.05及<0.01.②在十二指肠溃疡组与对照1组及对照2组的配对研究中,十二指肠溃疡组的CagA 阳性 Hp 感染率显著高于两个对照组,OR 分别为9.33与11.00,P 分别<0.05及<0.01.③1:1及1:2单因素及多因素 Logistic 回归分析表明,Caga 阳性 Hp 感染、吸烟、饮酒、食酸辣食物、生活不规律、精神因素等因素与胃十二指肠溃疡发病呈正相关,而按时进餐与胃十二指肠溃疡发病呈负相关.cagA 阳性 Hp 感染与胃溃疡及十二指肠溃疡的发生具有密切的相关性(OR=16.61-84.49).④双因素分层分析中,吸烟、饮酒、生活不规律、精神因素、食酸辣食物等因素与 CagA 阳性Hp 感染之间作用相互独立,但在胃十二指肠溃疡病的发生中具有协同作用.结论消化性溃疡的发生是众多因素共同作用的结果,CagA 阳性 Hp 菌株感染是引起胃溃疡及十二指肠溃疡多因素病因学中一个非常重要的、危险的因素.重视 CagA 阳性 Hp 菌株的研究,对预防和治疗消化性溃疡具有重要的临床意义和社会意义.
Objective To study the relationship between the infection of Helicobacter pylori-positive cell-associated protein A (CagA) -positive Hp strain and the pathogenesis of gastroduodenal ulcer in Xi’an from the perspective of epidemiology.Methods The case-control study, Ratio of 1: 2. Case group for the hospital from 1997-10 / 1998-10 Department of Gastroenterology consecutive hospitalized patients, confirmed by endoscopy and pathological examination of active gastric ulcer and (or) duodenal ulcer. The control group was divided into two groups, control group 1 was hospitalized in the same period undergraduate and other subjects hospitalized non-gastroduodenal disease patients, control group 2 for the same period of the census of healthy people.Comparison of case and control group, the ratio of sex, Nationality and age (within 5 years of difference) .A questionnaire was conducted on 32 factors that may be related to the pathogenesis of gastroduodenal ulcer and all the factors were quantified and processed by SAS software.CagA positive Hp infection test results The analysis was performed using the x ~ 2 test.And the factors under investigation were firstly analyzed by 1: 1 and 1: 2 single-factor conditional logistic regression analysis, and significant odds ratios (ORs) and 95% Confidence interval (conf idence interval, CI) .The two factors synergistic effect stratified analysis method.Univariate analysis of the larger role and the more accurate the investigation of the factors, using multivariate conditional Logistic regression analysis of serum anti-CagA antibody detection using spot gold (DIGFA) .Results ① In the paired study between gastric ulcer group and control group 1 and control group 2, the infection rate of CagA-positive Hp in gastric ulcer group was significantly higher than that of the two control groups, OR was 5.0 and 6.5 , P <0.05 and <0.01 respectively.②In the duodenal ulcer group and control group 1 and control group 2, the positive rate of CagA-positive Hp infection in duodenal ulcer group was significantly higher than that of the two control groups, OR were 9.33 and 11.00 respectively, P <0.05 and <0.01 respectively.③1: 1 and 1: 2 single factor and multivariate Logistic regression analysis showed that Caga positive Hp infection, smoking, drinking, eating hot and sour foods, Mental factors and other factors is positively correlated with the incidence of gastroduodenal ulcer, and mealtime is negatively correlated with the incidence of gastroduodenal ulcer.CagA-positive Hp infection is closely related to the occurrence of gastric ulcer and duodenal ulcer (OR = 16.61-84.49) .④ Two-factor In the layer analysis, smoking, alcohol drinking, irregular life, mental factors, hot and sour food and other factors were independent of CagA-positive Hp infection, but had synergistic effect on the occurrence of gastroduodenal ulcer disease.Conclusion Digestion The occurrence of ulcer is the result of many factors, CagA-positive Hp infection is one of the most important and dangerous factors in the pathogenesis of gastric ulcer and duodenal ulcer.Emphasis on CagA-positive Hp strain Prevention and treatment of peptic ulcer has important clinical significance and social significance.