Tseng G-Y, Lin H-J, Fang C-T, Yang H-B, Tseng G-C, Wang P-C, Hung T-L, Deng Y-C, Cheng Y-T, Huang C-H
Division of Gastroenterology, Ton-Yen General Hospital, Hsin-Chu, Taiwan.
Aliment Pharmacol Ther. 2007 Sep 15;26(6):925-33. doi: 10.1111/j.1365-2036.2007.03438.x.
The role of Helicobacter pylori in the pathogenesis of peptic ulcer disease in patients with uraemia remains unclear.
To evaluate the long-term effect of H. pylori eradication in these patients.
Uraemic and non-uraemic patients with peptic ulcer were enrolled in this study. Patients having history of non-steroidal anti-inflammatory drugs use or cardiovascular disease that need aspirin use were excluded. After confirmation of H. pylori infection, they received a triple therapy and were followed up for 2 years.
Between September 1999 and December 2005, 34 patients (41%) of the end-stage renal disease [H. pylori (+) group] and 67 (84%) of the non-uraemic patients with peptic ulcer disease (PU group) received anti-H. pylori therapy. After triple therapy, 32 (94%) from the end-stage renal disease group and 64 (96%) from the peptic ulcer group obtained successful eradication. During the 2-year follow-up, three patients in the end-stage renal disease group were excluded because of the presence of cardiovascular disease and aspirin use in two cases and died of heart failure in one case; two patients in peptic ulcer group refused follow-up. Finally, 29 uraemic and 62 non-uraemic patients had achieved the follow-up. Recurrence of peptic ulcer was more in the end-stage renal disease group than in the peptic ulcer group with intention-to-treat analysis (eight of 32, 25% vs. two of 64, 3%, P = 0.001, OR: 10.0, 95% CI: 1.979-50.540) or per-protocol analysis (eight of 29, 28% vs. two of 62, 3%, P < 0.001, OR: 11.4, 95% CI: 2.245-58.168).
Peptic ulcer recurrence after H. pylori eradication is higher in end-stage renal disease patients with peptic ulcer than in peptic ulcer patients without renal disease. Factors aside from H. pylori play an important role in peptic ulcer recurrence in end-stage renal disease patients.
幽门螺杆菌在尿毒症患者消化性溃疡病发病机制中的作用仍不明确。
评估根除幽门螺杆菌对这些患者的长期影响。
本研究纳入了患有消化性溃疡的尿毒症患者和非尿毒症患者。排除有非甾体抗炎药使用史或患有需要使用阿司匹林的心血管疾病的患者。确认幽门螺杆菌感染后，他们接受三联疗法并随访2年。
在1999年9月至2005年12月期间，34例终末期肾病患者（幽门螺杆菌阳性组）中的41%和67例非尿毒症消化性溃疡病患者（消化性溃疡组）中的84%接受了抗幽门螺杆菌治疗。三联疗法后，终末期肾病组中的32例（94%）和消化性溃疡组中的64例（96%）成功根除。在2年随访期间，终末期肾病组中有3例患者因存在心血管疾病且2例使用阿司匹林以及1例死于心力衰竭而被排除；消化性溃疡组中有2例患者拒绝随访。最终，29例尿毒症患者和62例非尿毒症患者完成了随访。在意向性分析（32例中的8例，25%对64例中的2例，3%，P = 0.001，OR：10.0，95%CI：1.979 - 50.540）或符合方案分析（29例中的8例，28%对62例中的2例，3%，P < 0.001，OR：11.4，95%CI：2.245 - 58.）中，消化性溃疡在终末期肾病组中的复发率高于消化性溃疡组。
根除幽门螺杆菌后，患有消化性溃疡的终末期肾病患者的消化性溃疡复发率高于无肾脏疾病的消化性溃疡患者。除幽门螺杆菌外的因素在终末期肾病患者消化性溃疡复发中起重要作用。
