Wachirawat W, Hanucharurnkul S, Suriyawongpaisal P, Boonyapisit S, Levenstein S, Jearanaisilavong J, Atisook K, Boontong T, Theerabutr C
Department of Medical and Surgical Nursing, Faculty of Nursing, Burapha University, Chon Buri, Thailand.
J Med Assoc Thai. 2003 Jul;86(7):672-85.
The purpose of this study was to clarify the relation between psychological and other risk factors, notably helicobacter pylori (H. pylori) infection, in contributing to the occurrence of peptic ulcer (PU) disease. A retrospective case-control study was conducted at Siriraj Hospital, Bangkok from March to December 2000. Seventy endoscopically diagnosed patients with new PU or peptic perforation were compared with 70 patients with other diseases as well as blood donors control matched for age and sex. Historical risk factors, H. pylori Immunoglobulin G antibody (H. pylori IgG Ab), stress (Perceived Stress Questionnaire) and hostility (MMPI Hostility Scale) were assessed. Data were analyzed using logistic regression analysis. The results showed that PU was associated with chronic stress (aOR 2.9, p = 0.01; 95% CI, 1.3-6.5) and family history of PU (aOR 2.4, p < 0.03; 95% CI, 1.1-5.1), with an interaction effect between stress and irregular mealtimes (aOR 4.8, p = 0.01; 95% CI, 1.3-16.9). The incidence rate of H. pylori infection in PU patients was similar to the control group (61.4% and 50.0%, respectively, OR 1.2). The authors conclude that stress and family history, not H. pylori infection, are important risk factors for PU in this population. This finding supports previous studies in Thailand, showing a high prevalence of H. pylori in the population but a low association with PU, in contrast to developed countries. It remains to be seen whether the impact of a family history is due to genetic factors or shared life-style patterns.
本研究的目的是阐明心理因素及其他风险因素，尤其是幽门螺杆菌（H. pylori）感染，在消化性溃疡（PU）疾病发生过程中的作用关系。2000年3月至12月，在曼谷诗里拉吉医院开展了一项回顾性病例对照研究。将70例经内镜诊断为新发PU或消化性穿孔的患者，与70例患有其他疾病的患者以及按年龄和性别匹配的献血者对照进行比较。评估了既往风险因素、幽门螺杆菌免疫球蛋白G抗体（H. pylori IgG Ab）、应激（感知应激问卷）和敌意（明尼苏达多项人格调查表敌意量表）。采用逻辑回归分析对数据进行分析。结果显示，PU与慢性应激（调整后比值比[aOR]为2.9，p = 0.01；95%置信区间[CI]为1.3 - 6.5）和PU家族史（aOR为2.4，p < 0.03；95% CI为1.1 - 5.1）相关，且应激与不规律进餐时间之间存在交互作用（aOR为4.8，p = 0.01；95% CI为1.3 - 16.9）。PU患者中幽门螺杆菌感染的发生率与对照组相似（分别为61.4%和58.6%，比值比[OR]为1.2）。作者得出结论，在该人群中，应激和家族史而非幽门螺杆菌感染是PU的重要风险因素。这一发现支持了泰国此前的研究，表明该国人群中幽门螺杆菌感染率高，但与PU的关联度低，这与发达国家的情况相反。家族史的影响是由于遗传因素还是共同的生活方式模式，仍有待观察。
