Papatheodoridis George V, Papadelli Despina, Cholongitas Evangelos, Vassilopoulos Dimitrios, Mentis Andreas, Hadziyannis Stephanos J
Academic Department of Medicine, Henry Dunant Hospital, Athens, Greece.
Am J Med. 2004 May 1;116(9):601-5. doi: 10.1016/j.amjmed.2003.10.040.
We evaluated whether infection with Helicobacter pylori, including specific cytotoxic-associated antigen (CagA)-positive strains, increase the risk of upper gastrointestinal bleeding in users of nonsteroidal anti-inflammatory drugs (NSAIDs).
Cases with upper gastrointestinal bleeding and recent NSAID use, including aspirin, who were admitted during 2001, were compared with age- and sex-matched outpatient controls who had recent NSAID use. H. pylori infection was diagnosed by serum antibodies or the (13)C-urea breath test; and CagA seropositivity was diagnosed by enzyme-linked immunoassay.
H. pylori was detected significantly more frequently in cases of bleeding than controls (79% [63/80] vs. 56% [45/80], P = 0.004). Cases of bleeding were more likely than controls to have a history of peptic ulcer (34% [n = 27] vs. 13% [n = 10], P = 0.003), previous upper gastrointestinal bleeding (19% [n = 15] vs. 6% [n = 5], P = 0.03), recent dyspepsia (29% [n = 23] vs. 15% [n = 12], P = 0.06), and <3 months of NSAID use (58% [n = 46] vs. 40% [n = 32], P = 0.04). CagA positivity was not associated with gastrointestinal bleeding. In a multivariate analysis, H. pylori infection was the only significant risk factor for upper gastrointestinal bleeding (odds ratio = 1.7; 95% confidence interval: 1.2 to 2.5; P = 0.004).
H. pylori infection almost doubles the risk of upper gastrointestinal bleeding among users of NSAIDs.
我们评估了幽门螺杆菌感染，包括特定的细胞毒素相关抗原（CagA）阳性菌株，是否会增加非甾体抗炎药（NSAIDs）使用者上消化道出血的风险。
将2001年期间因上消化道出血且近期使用过包括阿司匹林在内的NSAIDs而入院的患者，与年龄和性别匹配的近期使用过NSAIDs的门诊对照进行比较。通过血清抗体或碳-13尿素呼气试验诊断幽门螺杆菌感染；通过酶联免疫测定诊断CagA血清阳性。
出血患者中幽门螺杆菌的检出率显著高于对照组（79% [63/80] 对56% [45/80]，P = 0.004）。出血患者比对照组更有可能有消化性溃疡病史（34% [n = 27] 对13% [n = 10]，P = 0.003）、既往上消化道出血史（19% [n = 15] 对6% [n = 5]，P = 0.03）、近期消化不良（29% [n = 23] 对15% [n = 12]，P = 0.06）以及NSAIDs使用时间<3个月（58% [n = 46] 对40% [n = 32]，P = 0.
