-
幽门螺杆菌(Helicobacter pylori,HP)是一种革兰阴性螺旋形致病菌,通常寄生于人体胃黏膜内形成持续性感染,影响世界近一半的人口,对发展中国家的影响尤为显著[1]。人体一旦感染HP,可持续数年、数十年乃至终生,自愈率几乎为零。HP对机体的作用不仅局限于胃肠道,还可能与胃肠外疾病有关,例如它在糖尿病和胰岛素抵抗增加中发挥作用[2-3]。糖尿病是由于病人胰岛素分泌不足或其生物作用异常导致的一组以高血糖为特征的代谢性疾病[4]。2型糖尿病(T2DM)越来越普遍,并导致全世界每年约380万成人死亡。虽然T2DM的主要危险因素(如生活方式、遗传背景、社会经济因素)已被确定,但它们只能提供部分解释。近年来,HP感染与T2DM之间的关系一直是临床研究的热点问题,但HP感染是否为T2DM的独立危险因素仍有争议[4-6]。本文通过对T2DM病人中HP感染者和HP未感染者的血糖、血脂各项指标及糖化血红蛋白(HbA1c)的测定,研究HP对T2DM病人代谢水平的影响, 以期发现其是否可能参与代谢异常相关性疾病的发生和发展,为临床上预防和治疗T2DM的并发症提供新的思路及有效措施。
-
175例T2DM病人中,HP感染91例(52%),男61例,女30例,平均年龄(61.66±11.16)岁;HP未感染84例(48%),男62例,女22例,平均年龄(62.36±11.21)岁。感染HP的病人和未感染HP的病人在性别和年龄方面差异无统计学意义(P>0.05),具有可比性(见表 1)。
分组 n 年龄/岁 男 女 TC/(mmol/L) TG/(mmol/L) HDL/(mmol/L) LDL/(mmol/L) Glu/(mmol/L) LP-a/(mg/L) HbA1c/% HP感染组 91 61.66±11.16 61 30 4.92±1.20 2.01±1.80 1.39±0.40 2.61±1.00 10.24±5.00 252.95±137.45 8.74±2.11 HP未感染组 84 62.36 ±11.21 62 22 4.83±1.34 2.26±2.11 1.30±0.28 2.51±1.12 9.84±4.04 163.79±96.03 7.62±1.39 t — 0.41 0.96* 0.46 -0.83 1.72 0.68 0.57 5.00# 4.11 P — >0.05 >0.05 >0.05 >0.05 >0.05 >0.05 >0.05 < 0.01 < 0.01 *示χ2值;#示t′值 表 1 2组T2DM病人血清代谢相关指标的比较(x±s)
-
HP感染组和HP未感染组的T2DM病人血清TC、TG、HDL-C、LDL-C和Glu差异均无统计学意义(P>0.05);感染HP的T2DM病人血清LP-a和HbA1c水平高于HP未感染组,差异均有统计学意义(P < 0.01)(见表 1)。
-
T2DM病人HbA1c(%)>8的比例,HP感染者高于HP未感染者,差异有统计学意义(P < 0.01)(见表 2)。
分组 n HbA1c≤8% HbA1c>8% HP感染组 91 37 (44.4) 54(55.6) HP未感染组 84 56 (65.9) 28(34.1) χ2 — 11.87 P — < 0.01 表 2 T2DM病人HP感染与HbA1c表达水平的关系[n;百分率(%)]
幽门螺杆菌感染对2型糖尿病病人代谢水平的影响
Effect of Helicobacter pylori infection on metabolic levels in patients with type 2 diabetes mellitus
-
摘要:
目的探讨幽门螺杆菌(Helicobacter pylori,HP)感染对2型糖尿病(T2DM)病人代谢水平的影响。 方法共纳入175例T2DM病人,按HP感染情况分为HP感染组和HP未感染组。收集或检测每位病人的年龄、性别、血清总胆固醇(TC)、三酰甘油(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、脂蛋白-a(LP-a)、空腹血糖(Glu)、糖化血红蛋白(HbA1c)等。通过比较2组间的检测结果分析HP感染对T2DM病人代谢水平的影响。 结果175例T2DM病人中,HP感染91例(52%),HP未感染84例(48%),T2DM合并HP感染组血清LP-a和HbA1c(%)水平均高于HP未感染组(P < 0.01);T2DM病人HbA1c(%)>8的比例,HP感染者高于HP未感染者,差异有统计学意义(P < 0.01);2组间其他指标差异均无统计学意义(P>0.05)。 结论HP感染影响T2DM病人的血糖血脂代谢,可能参与代谢异常相关性疾病的发生和发展。 Abstract:ObjectiveTo investigate the effect of Helicobacter pylori(HP) infection on metabolic levels in patients with type 2 diabetes mellitus (T2DM). MethodsA total of 175 patients with T2DM were included in this study.These patients were divided into two groups as HP infection-positive or -negative.For each patient, the following data were collected or measured: age, gender and laboratory parameters including total cholesterol (TC), triglyceride(TG), high-density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), lipoprotein-a (LP-a), fasting blood glucose (Glu) and glycosylated hemoglobin (HbA1c).The influence of HP infection on the metabolic levels of T2DM patients was analyzed by comparing the results between the two groups. ResultsAmong 175 T2DM patients, 91 patients (52%) were HP positive and 84 patients (48%) were HP infection-negative.T2DM patients infected by HP showed significantly increased Lp-a and higher HbA1c than non-infected patients (P < 0.01).Additionally, 65.9% of the patients with HbA1c >8% were found to be HP positive, 55.6% of the patients with HbA1c ≤ 8% were HP positive.The levels of other parameters were not significantly different between two groups (P>0.05). ConclusionsHP infection affects blood glucose and lipid metabolism in patients with T2DM, which may be involved in the occurrence and development of metabolic disorder associated diseases. -
Key words:
- type 2 diabetes /
- Helicobacter pylori /
- metabolic levels
-
表 1 2组T2DM病人血清代谢相关指标的比较(x±s)
分组 n 年龄/岁 男 女 TC/(mmol/L) TG/(mmol/L) HDL/(mmol/L) LDL/(mmol/L) Glu/(mmol/L) LP-a/(mg/L) HbA1c/% HP感染组 91 61.66±11.16 61 30 4.92±1.20 2.01±1.80 1.39±0.40 2.61±1.00 10.24±5.00 252.95±137.45 8.74±2.11 HP未感染组 84 62.36 ±11.21 62 22 4.83±1.34 2.26±2.11 1.30±0.28 2.51±1.12 9.84±4.04 163.79±96.03 7.62±1.39 t — 0.41 0.96* 0.46 -0.83 1.72 0.68 0.57 5.00# 4.11 P — >0.05 >0.05 >0.05 >0.05 >0.05 >0.05 >0.05 < 0.01 < 0.01 *示χ2值;#示t′值 表 2 T2DM病人HP感染与HbA1c表达水平的关系[n;百分率(%)]
分组 n HbA1c≤8% HbA1c>8% HP感染组 91 37 (44.4) 54(55.6) HP未感染组 84 56 (65.9) 28(34.1) χ2 — 11.87 P — < 0.01 -
[1] HUNT RH, XIAO SD, MEGRAUD F, et al. Helicobacter pylori in developing countries. World Gastroenterology Organisation Global Guideline[J]. J Gastrointestin Liver Dis, 2011, 20(3): 299. [2] 周雪亮, 周渊, 朱强, 等. 幽门螺旋杆菌的研究进展[J]. 中国继续医学教育, 2019, 10(33): 101. [3] RIZZATTI G, MATTEO MV, IANIRO G, et al. Helicobacter pylori in metabolic related diseases[J]. Minerva Gastroenterol Dietol, 2018, 64(3): 297. [4] KAYAR Y, PAMUKÇU Ö, EROǦLU H, et al. Relationship between Helicobacter pylori infections in diabetic patients and inflammations, metabolic syndrome, and complications[J]. Int J Chronic Dis, 2015, 2015(290128): 6. [5] YANG GH, WU JS, YANG YC, et al. Gastric Helicobacter pylori infection associated with risk of diabetes mellitus, but not prediabetes[J]. J Gastroenterol Hepatol, 2014, 29(10): 1794. doi: 10.1111/jgh.12617 [6] ZHOU F, ZHONG X, CHEN J, et al. Helicobacter pylori infection associated with type 2 diabetic nephropathy in patients with dyspeptic symptoms[J]. Diabetes Res Clin Pract, 2015, 110(3): 328. doi: 10.1016/j.diabres.2015.09.008 [7] OLUYEMI A, ANOMNEZE E, SMITH S, et al. Prevalence of a marker of active Helicobacter pylori infection among patients with type 2 diabetes mellitus in Lagos, Nigeria[J]. BMC Res Notes, 2012, 5(1): 284. doi: 10.1186/1756-0500-5-284 [8] MARROLLO M, LATELLA G, MELIDE D, et al. Increased prevalence of Helicobacter pylori in patients with diabetes mellitus[J]. Dig Liver Dis, 2001, 33(1): 21. doi: 10.1016/S1590-8658(01)80131-6 [9] GENTILE S, TURCO S, OLIVIERO B, et al. The role of autonomic neuropathy as a risk factor of Helicobacter pylori infection in dyspeptic patients with type 2 diabetes mellitus[J]. Diabetes Res Clin Pract, 1998, 42(1): 41. doi: 10.1016/S0168-8227(98)00088-6 [10] GERMAN SV, BOBROVNITSKY IP. New aspects of Helicobacter pylori infection: Association with metabolic disturbances[J]. Ter Arkh, 2017, 89(10): 102. [11] KOUNTOURAS J, BOZIKI M, POLYZOS SA, et al. The emerging role of Helicobacter pylori-induced metabolic gastrointestinal dysmotility and neurodegeneration[J]. Curr Mol Med, 2017, 17(6): 389. [12] WANG JW, TSENG KL, HSU CN, et al. Association between Helicobacter pylori eradication and the risk of coronary heart diseases[J]. PLoS One, 2018, 13(1): e0190219. doi: 10.1371/journal.pone.0190219 [13] SAKITANI K, HIRATA Y, SUZUKI N, et al. Gastric cancer diagnosed after Helicobacter pylori eradication in diabetes mellitus patients[J]. BMC Gastroenterol, 2015, 15: 143. doi: 10.1186/s12876-015-0377-0 [14] VAFAEIMANESH J, RAJABZADEH R, AHMADI A, et al. Effect of Helicobacter pylori eradication on glycaemia control in patients with type 2 diabetes mellitus and comparison of two therapeutic regimens[J]. Arab J Gastroenterol, 2013, 14(2): 55. doi: 10.1016/j.ajg.2013.03.002 [15] GASBARRINI G, RACCO S, FRANCESCHI F, et al. Helicobacter pylori infection: from gastric to systemic disease[J]. Recenti Prog Med, 2010, 101: 27. [16] LONGO-MBENZA B, NSENGA JN, MOKONDJIMOBE E, et al. Helicobacter pylori infection is identified as a cardiovascular risk factor in Central Africans[J]. Vasc Health Risk Manag, 2012, 6: 455. [17] CAPLICE NM, PANETTA C, PETERSON TE, et al. Lipoprotein (a) binds and inactivates tissue factor pathway inhibitor: a novel link between lipoproteins and thrombosis[J]. Blood, 2001, 98(10): 2980. doi: 10.1182/blood.V98.10.2980 [18] NORDESTGAARD BG, CHAPMAN MJ, RAY K, et al. Lipoprotein(a) as a cardiovascular risk factor: current status[J]. Eur Heart, 2010, 31(23): 2844. doi: 10.1093/eurheartj/ehq386