Wu Ming-Shiang, Lee Wei-Jei, Wang Hsih-Hsi, Huang Shi-Pei, Lin Jaw-Town
Department of Primary Care Medicine, College of Medicine, National Taiwan University, Taipei.
Arch Intern Med. 2005 Jul 11;165(13):1552-5. doi: 10.1001/archinte.165.13.1552.
Obesity is an increasing health problem in developed countries, where the prevalence of Helicobacter pylori infection is decreasing. Recent studies suggested colonization of the stomach by H pylori might affect gastric expression of appetite- and satiety-related hormone and patients cured of H pylori infection gained weight. It was hypothesized that H pylori could be a contributing pathogenic factor in childhood and adult obesity.
To determine whether H pylori infection is linked to obesity, a case-control study composed of 414 patients with morbid obesity (a body mass index [calculated as weight in kilograms divided by the square of height in meters] of > or = 35 with serious comorbidity or a body mass index of > or = 40) and 683 control subjects (a body mass index of <25) with a comparable socioeconomic status was conducted. Immunoglobulin G antibodies against H pylori were measured from frozen serum samples by an enzyme-linked immunosorbent assay. Logistic regression was used to calculate the odds ratio (OR) and 95% confidence interval (CI).
The overall seropositivity was significantly lower in obese patients (181 [43.7%] of 414) than controls (410 [60.0%] of 683) (OR, 0.50; 95% CI, 0.39-0.65; P<.001). Differences in the estimated risk of the presence of H pylori were more pronounced in younger age groups, with ORs of 0.32 (95% CI, 0.10-1.00; P = .05) in those aged 10 to 19 years, 0.55 (95% CI, 0.34-0.89; P = .01) in those aged 20 to 29 years, 0.49 (95% CI, 0.30-0.80; P = .007) in those aged 30 to 39 years, and 0.58 (95% CI, 0.33-1.00; P = .05) in those aged 40 years or older.
Our data indicated an inverse relationship between morbid obesity and H pylori seropositivity. These findings raise the hypothesis that a lack of H pylori infection, especially during childhood, might enhance the risk of the development of morbid obesity.
在发达国家，肥胖已成为一个日益严重的健康问题，而幽门螺杆菌感染的患病率正在下降。最近的研究表明，幽门螺杆菌在胃内的定植可能会影响与食欲和饱腹感相关激素的胃表达，并且幽门螺杆菌感染治愈的患者体重增加。据推测，幽门螺杆菌可能是儿童和成人肥胖的一个致病因素。
为了确定幽门螺杆菌感染是否与肥胖有关，开展了一项病例对照研究，该研究由414例病态肥胖患者（体重指数[以千克为单位的体重除以以米为单位的身高的平方]≥35且伴有严重合并症，或体重指数≥40）和683名对照者（体重指数<25）组成，两组的社会经济地位相当。通过酶联免疫吸附测定法从冷冻血清样本中检测抗幽门螺杆菌的免疫球蛋白G抗体。采用逻辑回归计算比值比（OR）和95%置信区间（CI）。
肥胖患者的总体血清阳性率（414例中的181例[43.7%]）显著低于对照组（683例中的410例[60.0%]）（OR为0.50；9%置信区间为0.39 - 0.65；P<0.001）。幽门螺杆菌感染风险的估计差异在较年轻年龄组中更为明显，10至19岁年龄组的OR为0.32（95%置信区间为0.10 - 1.00；P = 0.05），20至29岁年龄组的OR为0.55（95%置信区间为0.34 - 0.89；P = 0.01），30至39岁年龄组的OR为0.49（95%置信区间为0.30 - 0.80；P = 0.007），40岁及以上年龄组的OR为0.58（95%置信区间为0.33 - 1.00；P = 0.05）。
我们的数据表明病态肥胖与幽门螺杆菌血清阳性率之间存在负相关关系。这些发现提出了一个假设，即缺乏幽门螺杆菌感染，尤其是在儿童时期，可能会增加患病态肥胖的风险。
