Bor-Shyang S, Chih-Hsein C, Hsiao-Bai Y, Shu-Chu S, Xi-Zhang L
Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan.
Hepatogastroenterology. 1998 Nov-Dec;45(24):2165-70.
BACKGROUND/AIMS: To determine whether severity of Helicobacter pylori (H. pylori) infection is aggravated during acute duodenal ulcer bleeding and related to bleeding severity.
One hundred and thirty-eight patients with H. pylori-infected bleeding duodenal ulcer and 112 non-bleeding cases were included in the study. A comparison was made of the anti-H. pylori IgG titer, endoscopic finding, density of H. pylori (range: 1-5) in the antrum, and severity of antral gastritis (score: 0-3) between bleeding and non-bleeding cases. The role of H. pylori in bleeding cases was further analyzed to survey its relationship to the severity of bleeding judged by clinical parameters. The H. pylori status of patients with rebleeding within the first week was compared to that of the non-rebleeding cases as well.
The anti-H. pylori IgG titer and H. pylori density of the non-bleeding group were lower than those of the bleeding group (0.466+/-0.288 vs. 0.912+/-0.559, p<0.001; 2.13+/-1.02 vs. 3.34+/-1.32, p<0.001). The percentages of bleeding ulcers in the study cases increased in a trend as the density of H. pylori increased (density: 1-5; 32.7%, 33.8%, 57.4%, 81.3%, 91.4%, p<0.001). Although the severity of gastritis and density of H. pylori disclosed an upward trend as bleeding severity increased, only ulcer size was significantly associated with bleeding severity (p<0.05). The 10 cases with recurrent bleeding had higher bacterial density and serological titer than the 128 non-rebleeding cases (p<0.005).
Heavy bacterial loads of H. pylori infection may precipitate bleeding episodes of duodenal ulcer. However, in bleeding duodenal ulcer, the status of H. pylori infection is not strongly associated with initial bleeding severity before therapeutic endoscopy. With the aim of enhancing hemostasis and preventing rebleeding, further studies could focus on diminishing the bacterial load of H. pylori during bleeding episodes.
背景/目的：确定幽门螺杆菌（H. pylori）感染的严重程度在急性十二指肠溃疡出血期间是否会加重，以及是否与出血严重程度相关。
本研究纳入了138例幽门螺杆菌感染的出血性十二指肠溃疡患者和112例非出血患者。比较了出血组和非出血组的抗幽门螺杆菌IgG滴度、内镜检查结果、胃窦部幽门螺杆菌密度（范围：1 - 5）以及胃窦炎严重程度（评分：0 - 3）。进一步分析幽门螺杆菌在出血病例中的作用，以研究其与根据临床参数判断的出血严重程度之间的关系。还比较了第一周内再出血患者与未再出血患者的幽门螺杆菌感染状况。
非出血组的抗幽门螺杆菌IgG滴度和幽门螺杆菌密度低于出血组（0.466±0.288对0.912±0.559，p<0.001；2.13±1.02对3.34±1.32，p<0.001）。随着幽门螺杆菌密度增加，研究病例中出血性溃疡的百分比呈上升趋势（密度：1 - 5；32.7%，33.8%，57.4%，81.3%，91.4%，p<0.001）。虽然胃炎严重程度和幽门螺杆菌密度随着出血严重程度增加呈上升趋势，但只有溃疡大小与出血严重程度显著相关（p<0.05）。10例再出血患者的细菌密度和血清学滴度高于128例未再出血患者（p<0.005）。
幽门螺杆菌感染的高细菌载量可能促使十二指肠溃疡出血发作。然而，在出血性十二指肠溃疡中，幽门螺杆菌感染状况与治疗性内镜检查前的初始出血严重程度没有密切关联。为了增强止血和预防再出血，进一步的研究可以聚焦于在出血发作期间降低幽门螺杆菌的细菌载量。
