Wang C H, Ma L R, Lin R C, Kuo J Y, Chang K K
Department of Internal Medicine, Tainan Municipal Hospital, Taiwan ROC.
J Formos Med Assoc. 1997 Jan;96(1):55-8.
There is a higher prevalence of peptic ulcer disease in cirrhotic patients than in the general population. Whether Helicobacter pylori is a risk factor for peptic ulcer in cirrhosis remains controversial. The aim of this study was to determine whether there is a significant correlation between H.pylori infection and peptic ulcer in liver cirrhosis. In a cross-sectional study, 49 cirrhotic patients underwent upper gastrointestinal endoscopy and 75 controls (health examinees) without liver disease were also examined by endoscopy. The presence of H. pylori was assessed by culture, histologic findings and rapid urease test of gastric antrum biopsy specimens. Thirty of the 49 (61%) cirrhotic patients had peptic ulcers as compared to 24 of the 75 (32%) controls. The frequency of H. pylori in the antrum in the cirrhotic group was significantly lower than in the control group (39% vs 69%). The presence of H. pylori was more frequent in control patients with gastric (75%) and duodenal ulcers (95%) than nonulcer control patients (59%) whereas the difference between patients with peptic ulcer and nonulcer (40% vs 37%) was not significant in cirrhotic patients. H. pylori was identified in 40% of the cirrhotic patients with duodenal ulcers compared with 95% of controls with duodenal ulcers (p < 0.05). Nevertheless, this difference was not significant among patients with a gastric ulcer between the two groups (40% vs 75%). There was no significant difference in the frequency of H. pylori infection among nonulcer patients between the cirrhotic and control groups (37% vs 59%). In conclusion, we found no evidence to substantiate an etiologic role of H. pylori in the development of a duodenal ulcer in cirrhotic patients.
肝硬化患者消化性溃疡疾病的患病率高于普通人群。幽门螺杆菌是否为肝硬化患者消化性溃疡的危险因素仍存在争议。本研究的目的是确定幽门螺杆菌感染与肝硬化患者消化性溃疡之间是否存在显著相关性。在一项横断面研究中，49例肝硬化患者接受了上消化道内镜检查，75名无肝脏疾病的对照者（健康体检者）也接受了内镜检查。通过对胃窦活检标本进行培养、组织学检查和快速尿素酶试验来评估幽门螺杆菌的存在情况。49例肝硬化患者中有30例（61%）患有消化性溃疡，而75名对照者中有24例（32%）患有消化性溃疡。肝硬化组胃窦中幽门螺杆菌的检出率显著低于对照组（39%对69%）。幽门螺杆菌在患有胃溃疡（75%）和十二指肠溃疡（95%）的对照患者中比无溃疡对照患者（59%）更常见，而在肝硬化患者中，消化性溃疡患者与无溃疡患者之间的差异（40%对37%）不显著。40%的肝硬化十二指肠溃疡患者检测到幽门螺杆菌，而十二指肠溃疡对照患者中这一比例为95%（p<0.05）。然而，两组胃溃疡患者之间的这一差异不显著（40%对75%）。肝硬化组和对照组的无溃疡患者中幽门螺杆菌感染率无显著差异（37%对59%）。总之，我们没有发现证据证实幽门螺杆菌在肝硬化患者十二指肠溃疡发生中起病因学作用。
