幽门螺杆菌感染与颈动脉斑块及心血管病危险因素的关系

摘要

目的 探讨幽门螺杆菌(Hp)感染与颈动脉斑块及心血管病危险因素的关系.方法 选择2014年1月至2015年3月于首都医科大学附属北京安贞医院行13C尿素呼气试验(13C-UBT)检测Hp及颈动脉彩色多普勒超声检查的健康体检者1 156名,依据13C-UBT检测结果将所有体检者分为Hp阳性组(412名)和Hp阴性组(744名).比较2组一般资料、实验室指标、颈动脉粥样硬化指标的差异,采用多因素Logistic回归方法分析Hp感染的相关因素.再将Hp阳性者根据Hp感染程度分为轻度组(180名)、中度组(143名)和重度组(89名),比较3组颈动脉内膜中层厚度(IMT)、颈动脉斑块以及心脏危险分层的差异.结果 Hp阳性组腹型肥胖者比例、总胆固醇、三酰甘油、低密度脂蛋白胆固醇(LDL-C)、C反应蛋白(CRP)、同型半胱氨酸(Hcy)水平均明显高于Hp阴性组,高密度脂蛋白胆固醇水平明显低于Hp阴性组,差异均有统计学意义(均P ＜0.05).Hp阳性组IMT明显高于Hp阴性组[1.01(0.78,1.95) mm比0.81(0.62,1.06) mm],不稳定斑块数比例明显高于Hp阴性组[51.6％(16/31)比26.2％ (11/42)],差异均有统计学意义(均P ＜0.05).多因素Logistic回归分析结果显示,总胆固醇、LDL-C、CRP、Hcy水平及不稳定斑块为Hp感染的相关因素(均P＜0.05).Hp感染轻度组、中度组和重度组IMT分别为0.89(0.63,1.32)、1.21(0.91,1.45)、1.43(1.02,1.92)mm,颈动脉斑块检出率分别为5.0％ (9/180)、7.7％(11/143)、12.4％ (11/89),不稳定斑块占比分别为2.2％ (4/180)、3.5％ (5/143)、7.9％ (7/89),两两比较差异均有统计学意义(均P＜0.05).经Spearman等级相关分析,Hp感染程度与IMT、颈动脉斑块检出率和不稳定斑块占比均呈正相关性(r=0.289,0.302,0.382,均P＜0.05).不同Hp感染程度患者心脏危险分层比较,差异均无统计学意义(均P ＞0.05).结论 Hp感染与血脂异常、炎性反应、Hcy升高等心血管危险因素及IMT、斑块形成、斑块稳定性密切相关,Hp参与动脉粥样硬化发生发展过程,增加心血管疾病发生风险.%Objective To analyze correlation among helicobacter pylori(HP) infection,carotid plaque and cardiovascular risk factors.Methods Totally 1 156 healthy people who had carbon 13-labeled urea breath test (13C-UBT) and carotid color ultrasonography from January 2014 to March 2015 in Beijing Anzhen Hospital,Capital Medical University were divided into Hp positive group(412 cases) and Hp negative group(744 cases).Clinical data,laboratory results and carotid atherosclerosis indexes were analyzed.The HP positive group was subdivided into 3 groups according to the degree of HP infection:mild group(180 cases),moderate group(143 cases) and severe group(89 cases).Carotid intima-media thickness(IMT),carotid plaque numbers and stability,cardiac risk stratification were analyzed.Multivative logistic regression and Spearman rank correlation analysis were used to analyze relative factors of Hp infection.Results In Hp positive group,the proportion of obese patients,levels of total cholesterol (TC),triacylglycerol,low density lipoprotein cholesterol (LDL-C),C-reactive protein (CRP),homocysteine(Hcy),carotid IMT and the proportion of unstable plaques were all significantly higher than those in Hp negative group(P ＜0.05);the level of high density lipoprotein cholesterol was significantly lower than that in Hp negative group(P ＜ 0.05).Multivariate logistic regression analysis showed that TC,LDL-C,CRP,Hcy and unstable plaques were correlated with Hp infection(P ＜0.05).In mild,moderate and severe HP infection groups,values of carotid IMT were 0.89 (0.63,1.32),1.21 (0.91,1.45) and 1.43 (1.02,1.92)mm;detection rates of carotid plaques were 5.0％ (9/180),7.7％ (11/143) and 12.4％ (11/89);proportions of unstable plaques were 2.2％ (4/180),3.5％ (5/143) and 7.9％ (7/89),respectively;differences of above records were all significant among 3 groups(P ＜ 0.05).Spearman rank correlation analysis showed that carotid IMT,detection rates of carotid plaques and proportions of unstable plaques were positively correlated with the degree of Hp infection (r =0.289,0.302,0.382,P ＜ 0.05).Cardiac risk stratification had no significant difference among mild,moderate and severe HP infection groups(P ＞ 0.05).Conclusion Hp infection is closely correlated with dyslipidemia,inflammation,elevated Hcy,carotid IMT,carotid plaque formation and plaque stability,increasing the risk of cardiovascular disease.