Liew W L, Walesby R K
Department of Cardiothoracic Surgery, The London Chest Hospital, UK.
Eur J Cardiothorac Surg. 1998 Jun;13(6):637-40. doi: 10.1016/s1010-7940(98)00075-x.
This study was designed to evaluate objectively the incidence of Helicobacter pylori infection and upper gastrointestinal (GI) bleeding in patients following heart valve replacement surgery. Since the discovery of Helicobacter pylori, its association with gastritis, peptic ulceration and upper GI bleed have been extensively studied. Anticoagulation of patients with mechanical heart valve prostheses is a prerequisite for the prevention of valve thrombosis and thrombo-embolic events. However anticoagulation can have its complications, notably that of upper GI bleeding.
Patients were assessed in routine postoperative outpatient clinics following cardiac valve replacement surgery. This assessment comprised initially of a questionnaire reflecting the symptomatology of upper GI bleeding and its subsequent management. With informed consent, a small sample of blood was obtained by stilette. The Helicobacter pylori status was assessed by measuring the presence of antibodies (immunoglobins) to Helicobacter pylori in a commercially available test kit, the Rapid Helisal Test. In this preliminary study 150 consecutive patients were scrutinised and their responses to the questionnaire were collected and compared with the Helisal test.
From the 150 patients studied, 37 patients were found to be positive to the Helisal test for Helicobacter pylori infection, representing 24.6% of all the cohorts. Of these 37 patients, eight gave a positive history of upper GI bleed; five requiring hospital admission with three requiring urgent upper GI endoscopy. Although these eight patients represent only 4.4% of the total group, it is significant to note that this represents 21.6% of those patients found to be Helicobacter pylori positive. There were no GI complications in any of those tested negative. There was an increasing incidence of Helicobacter pylori infection in the older age group of patients.
Helicobacter pylori infection is a common infection with serious consequences in heart valve surgery. For those requiring anticoagulation, the incidence of serious consequential upper GI bleed is significantly higher in the presence of this infection. Preoperative or immediate postoperative eradication of the organism is mandatory in those patients requiring indefinite anticoagulation.
本研究旨在客观评估心脏瓣膜置换术后患者幽门螺杆菌感染及上消化道出血的发生率。自幽门螺杆菌被发现以来，其与胃炎、消化性溃疡及上消化道出血的关联已得到广泛研究。对植入机械心脏瓣膜假体的患者进行抗凝是预防瓣膜血栓形成和血栓栓塞事件的前提条件。然而，抗凝可能会引发并发症，尤其是上消化道出血。
对心脏瓣膜置换术后的患者在常规门诊进行评估。该评估最初包括一份反映上消化道出血症状及其后续处理情况的问卷。在获得知情同意后，用细针采集少量血液样本。通过使用一种商用检测试剂盒——快速螺旋杆菌检测试剂盒，检测幽门螺杆菌抗体（免疫球蛋白）的存在情况，以此评估幽门螺杆菌感染状态。在这项初步研究中，对150例连续患者进行了详细检查，并收集了他们对问卷的回答，同时与螺旋杆菌检测结果进行比较。
在研究的150例患者中，有37例螺旋杆菌检测呈阳性，表明存在幽门螺杆菌感染，占所有研究对象的24.6%。在这37例患者中，有8例有上消化道出血的阳性病史；其中5例需要住院治疗，3例需要紧急进行上消化道内镜检查。尽管这8例患者仅占总研究组的4.4%，但值得注意的是，这占幽门螺杆菌检测呈阳性患者的21.6%。所有检测呈阴性的患者均未出现胃肠道并发症。老年患者组中幽门螺杆菌感染的发生率呈上升趋势。
幽门螺杆菌感染在心脏瓣膜手术中是一种常见且后果严重的感染。对于那些需要抗凝的患者，在存在这种感染的情况下，严重的上消化道出血并发症发生率显著更高。对于那些需要长期抗凝的患者，术前或术后立即根除该病原体是必不可少的。
