Svoboda Petr, Kantorova Ilona, Scheer Peter, Doubek Jaroslav, Ochmann Jiri, Rehorkova Dagmar, Bosakova Hana
Traumatological Hospital Brno, Research Center for Traumatology and Surgery, Brno, Czech Republic.
Hepatogastroenterology. 2004 Mar-Apr;51(56):476-80.
BACKGROUND/AIMS: The pathogenesis of acute stress-related hemorrhage in critically ill polytraumatized patients is uncertain and any role of Helicobacter pylori infection is unknown. The aim of our study was to evaluate the relationship between Helicobacter pylori serological status of patients developing stress-related bleeding and those with no appearance of upper gastrointestinal bleeding.
In our single-center prospective cohort study we investigated over a 3-year period all consecutive patients with upper gastrointestinal hemorrhage for Helicobacter pylori infection by serology. Control group comprised 101 such patients with no evidence of hemorrhage.
Of 396 assessable patients, stress-related upper gastrointestinal bleeding was observed in 11 (3.1%) patients. Six (55%) of the 11 bleeding patients and 45 (45%) of the 101 control group patients had serological evidence of Helicobacter pylori infection (p=0.5). Bleeding developed significantly more often in patients with more serious injury (for ISS, p=0.04, for TRISS p=0.03). Bleeding patients showed insignificantly higher mortality (36% vs. 15%; p=0.09).
Helicobacter pylori infection was not significantly more prevalent in polytraumatized patients with hemorrhage when compared with control group. Our data suggest that the infection with Helicobacter pylori does not play an important role in bleeding, indicating no causative role for it in upper gastrointestinal hemorrhage of polytraumatized patients. The incidence of bleeding is low and bleeding develops usually later, in the meantime is the Helicobacter pylori infection eradicated with the antibiotics used for another purpose.
背景/目的：重症多发伤患者急性应激相关出血的发病机制尚不确定，幽门螺杆菌感染在其中的作用也不清楚。本研究旨在评估发生应激相关出血的患者与未出现上消化道出血的患者的幽门螺杆菌血清学状态之间的关系。
在我们的单中心前瞻性队列研究中，我们在3年时间里通过血清学调查了所有连续性上消化道出血患者的幽门螺杆菌感染情况。对照组包括101例无出血证据的此类患者。
在396例可评估患者中，11例（3.1%）出现了应激相关上消化道出血。11例出血患者中有6例（55%）以及101例对照组患者中有45例（45%）有幽门螺杆菌感染的血清学证据（p = 0.5）。伤情更严重的患者出血发生率显著更高（损伤严重度评分，p = 0.04；创伤严重度特征评分，p = 0.03）。出血患者的死亡率略高（36% 对15%；p = 0.09）。
与对照组相比，创伤多发且出血患者的幽门螺杆菌感染率并无显著更高。我们的数据表明幽门螺杆菌感染在出血中并不起重要作用，提示其在创伤多发患者上消化道出血中无致病作用。出血发生率低且通常发生较晚，同时用于其他目的的抗生素是否能根除幽门螺杆菌感染。
