Süoglu Ozlem Durmaz, Gökçe Selim, Saglam Asli Toros, Sökücü Semra, Saner Günay
Department of Pediatric Gastroenterology, Hepatology and Nutrition, Istanbul University, Istanbul School of Medicine, Istanbul, Turkey.
Pediatr Int. 2007 Dec;49(6):858-63. doi: 10.1111/j.1442-200X.2007.02444.x.
The purpose of the present paper was to investigate the relationship between Helicobacter pylori infection and clinical symptomatology, breast-feeding and socioeconomic level. The relationship between H. pylori and iron-deficiency anemia (IDA) and the effect of H. pylori infection on growth were also investigated.
The subjects consisted of 70 patients aged 4-16 years who underwent upper gastrointestinal endoscopy for recurrent abdominal pain, nausea, vomiting, and dyspeptic complaints during a 2 year period. Patients were divided into two groups according to presence of histological evidence of H. pylori infection (group 1, H. pylori positive; group 2, H. pylori negative) and groups were compared with respect to epidemiologic characteristics, gastrointestinal complaints, height and weight SD scores and IDA.
Thirty-five (50%) of the 70 patients participating in the study were H. pylori positive. The mean age of group 1 was significantly higher than that of group 2. There were similar characteristics and symptomatology between groups. The majority of the patients in group 1 belonged to low socioeconomic class (class I and II; P < 0.05). The number of the patients exclusively breast-fed for > or =4 months was significantly higher in group 2 than in group 1. Gastritis was significantly more frequent in group 1. Mean hemoglobin, serum Fe and ferritin levels were 11.6 +/- 1.7 g/dL, 45.0 +/- 23.2 microg/dL and 11.9 +/- 8.4 microg/dL, respectively, for group 1 and 12.2 +/- 0.7 g/dL, 79.3 +/- 26.4 microg/dL and 42.1 +/- 31.8 microg/dL, respectively, for group 2. The mean serum Fe and ferritin levels of group 2 were significantly higher than those of group 1. IDA was observed in 20 (57.1%) and six (17.1%) patients in groups 1 and 2, respectively. IDA was significantly more frequent in group 1. Helicobacter pylori infection was found to be the only variable that had significant effect on IDA. Mean SD height and weight for group 1 were lower than those of the group 2. When the patients were evaluated in four groups according to H. pylori and IDA status, mean height SD score of patients with both H. pylori infection and IDA was significantly lower than that of the patients negative for H. pylori and IDA concomitantly.
Low socioeconomic status seems to be an important risk factor for H. pylori infection. Exclusive breast-feeding at least for 4 months can have a protective role against H. pylori infection. Increased frequency of growth retardation and IDA in H. pylori-infected patients in the present study supports similar findings in the literature, although there is still need for detailed studies to clarify the causative mechanisms.
本文旨在研究幽门螺杆菌感染与临床症状、母乳喂养及社会经济水平之间的关系。同时还研究了幽门螺杆菌与缺铁性贫血（IDA）的关系以及幽门螺杆菌感染对生长发育的影响。
研究对象为70例4至16岁的患者，他们在两年内因反复出现腹痛、恶心、呕吐及消化不良症状而接受了上消化道内镜检查。根据幽门螺杆菌感染的组织学证据将患者分为两组（第1组，幽门螺杆菌阳性；第2组，幽门螺杆菌阴性），并比较两组的流行病学特征、胃肠道症状、身高和体重标准差评分以及IDA情况。
参与研究的70例患者中有35例（50%）幽门螺杆菌阳性。第1组的平均年龄显著高于第2组。两组之间的特征和症状相似。第1组中的大多数患者属于社会经济地位较低的阶层（I和II类；P < 0.05）。第2组中纯母乳喂养≥4个月的患者数量显著多于第1组。第1组中胃炎的发生率明显更高。第1组的平均血红蛋白、血清铁和铁蛋白水平分别为11.6±1.7 g/dL、45.0±23.2 μg/dL和11.9±8.4 μg/dL，第2组分别为12.2±0.7 g/dL、79.3±26.4 μg/dL和42.1±31.8 μg/dL。第2组的平均血清铁和铁蛋白水平显著高于第1组。第1组和第2组分别有20例（57.1%）和6例（17.1%）患者出现IDA。第1组中IDA的发生率明显更高。发现幽门螺杆菌感染是对IDA有显著影响的唯一变量。第1组的平均身高和体重标准差低于第2组。当根据幽门螺杆菌和IDA状态将患者分为四组进行评估时，同时感染幽门螺杆菌和IDA的患者的平均身高标准差评分显著低于同时幽门螺杆菌和IDA均为阴性的患者。
社会经济地位低似乎是幽门螺杆菌感染的一个重要危险因素。至少纯母乳喂养4个月可对幽门螺杆菌感染起到保护作用。本研究中幽门螺杆菌感染患者生长发育迟缓及IDA发生率增加，这与文献中的类似发现相符，尽管仍需要详细研究来阐明其致病机制。
