Moshkowitz M, Brill S, Konikoff F M, Averbuch M, Arber N, Halpern Z
Department of Gastroenterology, Tel Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Israel.
Isr Med Assoc J. 2000 Dec;2(12):892-5.
Cigarette smoking has long been regarded as an important factor in the pathogenesis of peptic ulcer disease.
To investigate whether cigarette smoking has an additive effect on the clinical presentation and course of disease in Helicobacter pylori-positive dyspeptic patients.
The study group comprised 596 consecutive H. pylori-positive dyspeptic patients (334 males and 262 females, mean age 50.6, range 12-81 years). Following upper gastrointestinal endoscopy, patients were subdivided by diagnosis as follows: Non-ulcer patient group (n = 312: gastritis 193, duodenitis 119), gastric ulcer (n = 19), and duodenal ulcer (n = 265). H. pylori infection was confirmed by histology and/or rapid urease test. In addition, 244 patients had a positive 14C-urea breath test prior to antimicrobial treatment. The patients' medical history and smoking habits were obtained using a detailed questionnaire completed by the patients and their referring physicians.
There were 337 non-smoking patients, 148 current smokers and 111 past smokers. Gastric and duodenal ulcers were significantly less prevalent in non-smokers than in current or past smokers (gastric 1.8%, 4.1%, 6.3%; duodenal 39.8%, 50%, 51.4%, respectively) (P < 0.05). The incidence of gastrointestinal bleeding was significantly lower in non-smokers than in current or past smokers (7.1%, 8.1% and 20.7%, respectively) (P < 0.05). Bacterial density, as assessed by the UBT value in 244 patients, was higher in non-smokers (mean 352.3 +/- 273 units) than in past smokers (mean 320.8 +/- 199) or current-smokers (mean 229.9 +/- 162) (P < 0.05). Logistic regression analysis revealed that male gender, current smoking, and immigration from developing countries were all significant independent risks for developing duodenal ulcer, while only past smoking was associated with a higher rate of upper gastrointestinal bleeding in the past.
In H. pylori-positive dyspeptic patients, current smoking as well as male gender and immigration from developing countries are associated with an increased risk for duodenal ulcer. This effect does not seem to be related to the bacterial density or increased urease activity of H. pylori organisms.
长期以来，吸烟一直被视为消化性溃疡病发病机制中的一个重要因素。
探讨吸烟是否会对幽门螺杆菌阳性的消化不良患者的临床表现和病程产生叠加影响。
研究组包括596例连续的幽门螺杆菌阳性的消化不良患者（男性334例，女性262例，平均年龄50.6岁，范围12 - 81岁）。在上消化道内镜检查后，患者按诊断分为以下几组：非溃疡患者组（n = 312：胃炎193例，十二指肠炎119例）、胃溃疡（n = 19）和十二指肠溃疡（n = 265）。通过组织学和/或快速尿素酶试验确认幽门螺杆菌感染。此外，244例患者在抗菌治疗前14C尿素呼气试验呈阳性。通过患者及其转诊医生填写的详细问卷获取患者的病史和吸烟习惯。
有337例非吸烟患者、148例当前吸烟者和111例既往吸烟者。非吸烟者中胃溃疡和十二指肠溃疡的患病率显著低于当前吸烟者或既往吸烟者（胃溃疡分别为1.8%、4.1%、6.3%；十二指肠溃疡分别为39.8%、50%、51.4%）（P < 0.05）。非吸烟者胃肠道出血的发生率显著低于当前吸烟者或既往吸烟者（分别为7.1%、8.1%和20.7%）（P < 0.05）。在244例患者中，通过UBT值评估的细菌密度，非吸烟者（平均352.3 ± 273单位）高于既往吸烟者（平均320.8 ± 199）或当前吸烟者（平均229.9 ± 162）（P < 0.05）。逻辑回归分析显示，男性、当前吸烟以及来自发展中国家的移民都是发生十二指肠溃疡的显著独立危险因素，而只有既往吸烟与过去上消化道出血的较高发生率相关。
在幽门螺杆菌阳性的消化不良患者中，当前吸烟以及男性和来自发展中国家的移民与十二指肠溃疡风险增加相关。这种影响似乎与幽门螺杆菌的细菌密度或脲酶活性增加无关。
