Schubert T T, Bologna S D, Nensey Y, Schubert A B, Mascha E J, Ma C K
Department of Medicine, Henry Ford Hospital, Detroit, Michigan.
Am J Med. 1993 Apr;94(4):413-8. doi: 10.1016/0002-9343(93)90153-g.
To evaluate the influence of Helicobacter pylori, nonsteroidal anti-inflammatory drug (NSAID) use, tobacco and alcohol use, age, gender, ethnic group, and the indication for endoscopy on the frequency of gastric and duodenal ulcers in patients referred for upper endoscopy.
One thousand eighty-eight consecutive patients without prior antrectomy or active bleeding at endoscopy who were able to provide a history were interviewed prior to endoscopy, and antral biopsies were performed for H. pylori at endoscopy. Variables were tested for univariate association with duodenal or gastric ulcer and those variables with p < 0.25 were included in the logistic regression model building.
One hundred seven patients had duodenal ulcer, 97 had gastric ulcers, and 5 had both. Significant risk factors in the final model for duodenal ulcer were H. pylori, history of previous ulcer, male gender, bleeding, and pain at presentation (p < 0.001), whereas alcohol was associated with a decreased risk (p = 0.026). H. pylori presence (p = 0.011), aspirin use (p = 0.009), and bleeding (p = 0.012) were associated with gastric ulcer in the final model; esophageal symptoms were associated with decreased risk of gastric ulcer (p = 0.003). NSAID use was associated with gastric ulcers only in those over 55 (p < 0.05), especially whites, and in nonwhites without prior ulcer. There was no interaction between H. pylori and NSAIDs.
H. pylori was associated with an increased risk of duodenal and gastric ulcers. Aspirin increases the risk for gastric ulcer in patients of all ages, whereas nonaspirin, nonsteroidal use increases the risk for gastric ulcers to varying degrees in patients over age 55, depending on race and history of ulcer.
评估幽门螺杆菌、非甾体抗炎药（NSAID）使用、吸烟和饮酒、年龄、性别、种族以及内镜检查指征对上消化道内镜检查患者胃和十二指肠溃疡发生率的影响。
对188例既往未行胃窦切除术且内镜检查时无活动性出血、能够提供病史的连续患者在进行内镜检查前进行访谈，并在内镜检查时取胃窦活检标本检测幽门螺杆菌。对变量进行十二指肠溃疡或胃溃疡的单因素关联检验，将p<0.25的变量纳入逻辑回归模型构建。
107例患者有十二指肠溃疡，97例有胃溃疡，5例两者均有。十二指肠溃疡最终模型中的显著危险因素为幽门螺杆菌、既往溃疡病史、男性、出血和就诊时疼痛（p<0.001），而饮酒与风险降低相关（p=0.026）。最终模型中，幽门螺杆菌感染（p=0.011）、阿司匹林使用（p=0.009）和出血（p=0.012）与胃溃疡相关；食管症状与胃溃疡风险降低相关（p=0.003）。NSAID使用仅在55岁以上人群中与胃溃疡相关（p<0.05），尤其是白人，以及既往无溃疡的非白人。幽门螺杆菌与NSAIDs之间无相互作用。
幽门螺杆菌与十二指肠溃疡和胃溃疡风险增加相关。阿司匹林增加各年龄段患者胃溃疡风险，而非阿司匹林类非甾体抗炎药在55岁以上患者中根据种族和溃疡病史不同程度增加胃溃疡风险。
