摘要：
目的:探讨乙型肝炎肝硬化合并上消化道出血与幽门螺杆菌(HP)感染的关系,为临床诊疗提供理论依据.方法:选取2011年1月至2015年1月就诊于本院的乙型肝炎肝硬化合并上消化道出血者87例,根据患者年龄所在的区段将其分为A组(40 ～50岁)、B组(51～60岁)、C组(大于60岁)3组,均采用碳14呼气试验对所有患者进行HP感染检测,观察3组患者HP检测的阳性率及不同性别、不同肝功能级别以及不同类型的乙型肝炎肝硬化上消化道出血组间HP感染阳性率的差异.结果:87例乙型肝炎肝硬化合并上消化道出血患者中,55例(63.2％)HP检测阳性,男、女性的感染阳性率分别为64.2％和61.8％,差异无统计学意义(P＞0.05);A组患者18例(50.0％)HP检测阳性,B组患者21例(70.0％)阳性,C组患者16例(76.2％)阳性,患者随着年龄的增大,HP检测的阳性率逐渐升高,且C组与A、B两组比较,差异有统计学意义(P＜0.05),A、B两组间比较,差异无统计学意义(P＞0.05);乙型肝炎肝硬化合并门脉高压性胃病出血患者HP阳性5例(31.2％),乙型肝炎肝硬化合并食管胃静脉曲张破裂出血患者HP阳性15例(71.4％),乙型肝炎肝硬化合并消化道溃疡出血患者32例(82.1％)阳性,乙型肝炎肝硬化合并原因不明出血患者3例(27.3％)阳性,乙型肝炎肝硬化合并消化道溃疡出血患者的HP感染率最高,但与乙型肝炎肝硬化合并食管胃静脉曲张破裂出血比较,差异无统计学意义(P＞0.05),乙型肝炎肝硬化合并食管胃静脉曲张破裂出血和消化道溃疡出血的幽门螺杆菌检测阳性率明显高于乙型肝炎肝硬化合并门脉高压性胃病出血和原因不明出血,差异有统计学意义(P ＜0.05);Child-Pugh分级肝功能A级患者HP检测30例(63.8％)阳性,B级患者14例(60.9％)阳性,C级患者11例(64.7％)阳性,三种级别肝功能的乙型肝炎肝硬化合并上消化道出血幽门螺杆菌检测阳性率无明显差异(P＞0.05).结论:HP感染与乙型肝炎肝硬化合并上消化道出血关系密切,根治HP感染,是乙型肝炎肝硬化上消化道出血的一项有效的预防措施.%Objective:To explore the relationship between Hepatitis B cirrhosis combined upper gastrointestinal hemorrhage and the helicobacter pylori infection.Methods:87 cases of hepatitis B cirrhosis combined upper gastrointestinal bleeding were collected from January 2011 to January 2011 in our hospital.The patients were divided into group A (40 to 50 years old),group B (51 to 60 years old),three group (＞ 60 years) according to the age.Helicobacter pylori infection were tested through carbon 14 breath test for all groups,and the positive rate of Helicobacter pylori detection and the difference of positive rate of HP infection among different sex,different liver function levels and different types of hepatitis B cirrhosis and upper gastrointestinal bleeding group also tested amoung three groups.Results:The positive rates of Helicobacter pylori was 55 cases (63.2％),while,64.2％ and 61.8％ respectively in males and females (P ＞ 0.05);The case of HP positive was 18 (50％),21 (70％) and 16 (76.2％) in A,B,C group respectively.With the increase of age,the positive rate of HP detection increased gradually in the three groups,and the difference between the C group and the A group and the B group was statistically significant (P ＜ 0.05),and there was no significant difference between the two groups (P ＞ 0.05) in A and B group;The number of positive of HP in Hepatitis B hepatocirrhosis with portal hypertension gastropathy hemorrhage sex was5 cases (31.2％);while,hepatitis B cirrhosis combined esophageal gastric varices rupture hemorrhage was 15 cases (71.4％);hepatitis B cirrhosis combined digestive tract ulcer bleeding was 32 (82.1％);hepatitis B cirrhosis combined unexplained bleeding was 3 (27.3％).The rate of HP infection was biggest in hepatitis B cirrhosis combined digestive tract ulcer bleeding,but hepatitis B cirrhosis combined esophageal and gastric varices rupture hemorrhage has no statistically significant difference (P ＞ 0.05);hepatitis B cirr hosis combined esophageal gastric varices rupture hemorrhage and digestive tract ulcer bleeding helicobacter pylori detection were significantly higher than hepatitis B,hepatocirrhosis with portal hypertension gastropathy hemorrhage and unexplained bleeding,the difference was statistically significant (P ＜ 0.05);Child-Pugh class liver function was A HP positive detection of 30 patients (63.8 ％),grade B 14 cases (60.9％) were positive,C grade 11 cases (64.7 ％) were positive,three levels of liver function of hepatitis B cirr hosis combined upper gastrointestinal bleeding helicobacter pylori detection rate of no significant difference (P ＞ 0.05).Conclusion:HP infection was closely related to upper gastrointestinal bleeding in patients with hepatitis B and cirrhosis.Radical HP infection was an effective preventive measure for upper gastrointestinal bleeding of hepatitis B cimhosis.
