Endoscopy Center, Tokyo Medical University Hospital, Tokyo, Japan.
J Gastroenterol Hepatol. 2012 Apr;27 Suppl 3:76-81. doi: 10.1111/j.1440-1746.2012.07077.x.
Low-dose aspirin (LDA), and Helicobacter pylori (HP) infection are considered the two primary causes of peptic ulceration. The interaction between HP infection and non-steroidal anti-inflammatory drugs is, however, a matter of considerable discussion and controversy. In this study, we investigated possible synergistic or negative interactions between HP infection and LDA in gastric mucosal lesions, according to lesion site.
The subjects were 120 patients attending the Cardiology Outpatients Department (average age, 67.1 ± 8.9 years; male : female ratio 2.9:1). Endoscopic findings were graded using the Modified Lanza score. Lesions were scored for the antral, body and fundal regions. Ulcers were defined as mucosal defects ≥ 5 mm in size.
There were 55 HP-positive and 65 HP-negative subjects, and 91 subjects on LDA therapy. The gastric antral Lanza scores were HP(-) LDA(-): 0.2 ± 1.6, HP(-) LDA(+): 1.8 ± 1.5, HP(+) LDA(-): 0.3 ± 0.7, and HP(+) LDA(+): 0.5 ± 1.0. The gastric body and fundal Lanza scores were 0.0 ± 0.0, 0.8 ± 0.9, 0.4 ± 1.1, and 1.0 ± 1.5, respectively, and 0.1 ± 0.3, 0.5 ± 0.9, 0.1 ± 0.3, and 0.1 ± 0.3, respectively. Variance analysis of the correlation between HP infection and LDA by regional Lanza scores identified both HP infection and LDA use as factors that significantly influence the antral Lanza score. However, LDA was an aggressive factor, and HP infection a protective factor. In the gastric body, LDA was a non-significant, and HP infection a significant, aggressive factor. In the gastric fundus, neither HP infection nor LDA was a significant factor (LDA was an aggressive factor, and HP infection a protective factor).
LDA had aggressive effects in all gastric lesions; on the other hand, HP infection had protective effects in the antrum and fundus in the stomach, and aggressive effects in the body in the stomach.
小剂量阿司匹林（LDA）和幽门螺杆菌（HP）感染被认为是消化性溃疡形成的两个主要原因。然而，HP 感染与非甾体抗炎药之间的相互作用仍然存在很大的争议。本研究根据病变部位，探讨 HP 感染与 LDA 在胃黏膜病变中的协同或拮抗作用。
研究对象为心内科门诊患者 120 例（平均年龄 67.1±8.9 岁；男女比例 2.9:1）。内镜检查采用改良 Lanza 评分进行分级。对胃窦、胃体和胃底进行评分。溃疡定义为黏膜缺损≥5mm。
HP 阳性 55 例，HP 阴性 65 例，LDA 治疗 91 例。胃窦 Lanza 评分分别为 HP（-）LDA（-）：0.2±1.6，HP（-）LDA（+）：1.8±1.5，HP（+）LDA（-）：0.3±0.7，HP（+）LDA（+）：0.5±1.0。胃体和胃底 Lanza 评分分别为 0.0±0.0，0.8±0.9，0.4±1.1，1.0±1.5 和 0.1±0.3，0.5±0.9，0.1±0.3，0.1±0.3。根据区域性 Lanza 评分，对 HP 感染与 LDA 相关性的方差分析发现，HP 感染和 LDA 使用均为影响胃窦 Lanza 评分的显著因素。然而，LDA 是一个侵袭因素，HP 感染是一个保护因素。在胃体中，LDA 是非显著的，HP 感染是一个显著的侵袭因素。在胃底，HP 感染和 LDA 均不是显著因素（LDA 是侵袭因素，HP 感染是保护因素）。
LDA 在所有胃病变中均有侵袭作用；另一方面，HP 感染在胃窦和胃底有保护作用，在胃体有侵袭作用。
