Huang Wei-Shih, Yang Tse-Yen, Shen Wei-Chih, Lin Cheng-Li, Lin Ming-Chia, Kao Chia-Hung
Department of Neurology, China Medical University Hospital, Taichung, Taiwan; Graduate Institute of Clinical Medicine Science and School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan.
Molecular and Genomic Epidemiology Center, China Medical University Hospital, China Medical University, Taichung, Taiwan.
J Clin Neurosci. 2014 Aug;21(8):1355-8. doi: 10.1016/j.jocn.2013.11.018. Epub 2014 Feb 6.
Dementia is the severe loss of global cognitive ability in a previously healthy person. This study examined the relationship between Helicobacter pylori infection (HP-I) and non-Alzheimer's dementia (non-AD) using a nationwide population-based dataset. The International Classification of Diseases, Ninth Revision (ICD-9) codes for dementia were used to define dementia patients; in addition, we examined the association of dementia with other comorbidities. Patients aged ≥40years with newly diagnosed HP-I (ICD-9 code 041.86) during 1998-2010 were identified as the HP-I cohort. The comparison cohort consisted of people aged ≥40years without HP-I (non-HP-I) randomly selected from the database at a ratio of 1:4 in the same time period. The controls were frequency matched according to the age (every 5years), sex, and index year of patients in the HP-I cohort. Follow-up was performed for all patients until the date of dementia diagnosis (ICD-9 codes 290.0-290.4, 294.1, 331.0-331.2), date of withdrawal from the Taiwanese National Health Insurance program, date of death, or until December 31 2010. Compared with patients without HP-I, HP-I patients were 1.60-fold (95% confidence interval [CI] 1.32-1.95) more likely to develop non-AD. There was no statistical association between HP-I and AD. The adjusted hazard ratio of dementia increased from 1.48 (95% CI 1.22-1.79) for patients who had HP-I once to 2.19 (95% CI 1.13-4.25) for patients who had HP-I two or more times. Our study revealed that HP-I may be a critical risk factor for the development of non-AD. Further investigation, including clinical trials, to examine the microbe-dementia connection may provide further proof of the association between HP-I and dementia.
痴呆症是指原本健康的人出现严重的整体认知能力丧失。本研究使用全国性的基于人群的数据集，探讨了幽门螺杆菌感染（HP-I）与非阿尔茨海默病性痴呆（non-AD）之间的关系。采用国际疾病分类第九版（ICD-9）中痴呆症的编码来定义痴呆症患者；此外，我们还研究了痴呆症与其他合并症之间的关联。1998年至2010年期间新诊断为HP-I（ICD-9编码041.86）且年龄≥40岁的患者被确定为HP-I队列。比较队列由同一时期从数据库中以1:4的比例随机选取的年龄≥40岁且无HP-I（非HP-I）的人群组成。根据HP-I队列中患者的年龄（每5年一组）、性别和索引年份对对照组进行频率匹配。对所有患者进行随访，直至痴呆症诊断日期（ICD-9编码290.0 - 290.4、294.1、331.0 - 331.2）、退出台湾国民健康保险计划的日期、死亡日期或直至2010年12月31日。与无HP-I的患者相比，HP-I患者患non-AD的可能性高1.60倍（95%置信区间[CI] 1.32 - 1.95）。HP-I与AD之间无统计学关联。痴呆症的调整后风险比从HP-I发作一次的患者的1.48（95% CI 1.22 - 1.79）增加到HP-I发作两次或更多次的患者的2.19（95% CI 1.13 - 4.25）。我们的研究表明，HP-I可能是非AD发生的关键危险因素。进一步的研究（包括临床试验）以检验微生物与痴呆症之间的联系，可能会为HP-I与痴呆症之间的关联提供更多证据。
