Investigation and analysis of risk factors for Helicobacter pylori infection in 10 016 examined populations in Xi'an
-
摘要: 目的 调查西安地区门诊与体检人群幽门螺杆菌(Hp)感染的流行病学特征，分析相关危险因素。方法 收集2016年9月—2020年12月于西安交通大学第二附属医院行13C尿素呼气试验的门诊与体检人群的临床资料，完成基本情况的单因素分析、影响因素的单因素分析、危险因素的logistic回归分析。结果 在10 016例门诊与体检人群中，Hp感染阳性3255例，感染率为32.50%。基本情况的单因素分析示，各年龄段Hp感染率差异有统计学意义(P< 0.05)，老年组感染率最高，其次为中年及青年组。男性、少数民族、农村地区Hp感染率显著高于女性、汉族、城市地区，差异均有统计学意义(P< 0.01)。工人、农民、服务人员人群的整体Hp感染率最高，其次为学生、自由职业者人群，最低为公职人员、医护人员、教师人群，差异均有统计学意义(P< 0.01)。不同婚姻状况人群Hp感染率差异无统计学意义(P>0.05)。影响因素的单因素分析示，有消化系统症状、不洁饮食史、吸烟史、饮酒史、Hp感染家族史、冠心病史人群的Hp感染率显著高于无消化系统症状、卫生饮食、无吸烟史、无饮酒史、无Hp感染家族史、非冠心病者，差异均有统计学意义(P< 0.01)。各体质指数(BMI)异常组Hp感染率显著高于BMI正常组，差异均有统计学意义(P< 0.01)，BMI肥胖组Hp感染率最高，其次为BMI超重组及过轻组。有胃镜报告及糖尿病史人群Hp感染率差异无统计学意义(P>0.05)。logistic回归分析示，居住地区、消化系统症状、BMI、不洁饮食史、饮酒史、Hp感染家族史均为Hp感染的独立危险因素(P< 0.01)。而年龄、性别、民族、职业、吸烟史、冠心病史虽然影响Hp感染率，但差异无统计学意义(P>0.05)。结论 西安地区门诊与体检人群Hp感染率为32.50%，Hp感染的独立危险因素为居住地区、消化系统症状、BMI、不洁饮食史、饮酒史及Hp感染家族史。Abstract: Objective To investigate the epidemiological characteristics ofHelicobacter pylori(Hp) infection in outpatients and physical examination population in Xi'an and analyze related risk factors.Methods The clinical data of outpatients and physical examination populations who underwent 13C urea breath test in the Second Affiliated Hospital of Xi'an Jiaotong University from September 2016 to December 2020 were collected, and complete single factor analysis of basic conditions and influencing factors, and finish logistic regression analysis were completed.Results Among 10 016 outpatients and physical examinations, 3255 Hp infections were positive, and the infection rate was 32.50%. Univariate analysis of the basic situation showed that the Hp infection rate of each age group had a statistically significant difference(P< 0.05). The infection rate of the elderly group was the highest, followed by the middle-aged and young groups. The infection rates of Hp in men, ethnic minorities, and rural areas were significantly higher than that in female, the Han nationality, urban areas, and the differences were statistically significant(allP< 0.01). The overall Hp infection rate among workers, farmers, and service personnel was the highest, followed by students and freelancers, and the lowest among public officials, medical staff, and teachers. The differences were statistically significant(allP< 0.01). There was no significant difference in Hp infection rate among people with different marital status groups(P>0.05). A single factor analysis of influencing factors showed that Hp infection rates of people with digestive symptoms, history of unclean diet, smoking, drinking, family history of Hp infection, and history of coronary heart disease were significantly higher than that of people without digestive system symptoms, history of unclean diet, smoking, drinking, family history of Hp infection, and coronary heart disease(P< 0.01). The infection rate of Hp in each abnormal body mass index(BMI) group was significantly higher than that in the normal BMI group, and the differences were statistically significant(P< 0.01). The Hp infection rate in the obese BMI group was the highest, followed by overweight BMI and underweight groups. There was no statistically significant difference in Hp infection rate among people with gastroscopy report and history of diabetes mellitus(P>0.05).Logistic regression analysis showed that residential area, digestive system symptoms, BMI, history of unclean diet, history of drinking, and family history of Hp infection were all independent risk factors for Hp(allP< 0.01). Although age, gender, ethnicity, occupation, smoking history, and history of coronary heart disease affected Hp infection rate, the difference was not statistically significant(P>0.05).Conclusion The infection rate of Hp was 32.50% in outpatients and physical examinations in Xi'an is 32.50%. The independent risk factors for Hp infection were residential area, digestive system symptoms, BMI, history of unclean diet, history of drinking, and family history of Hp infection.
-
Key words:
- Helicobacter pylori /
- infection rate /
- epidemiology /
- risk factors /
- correlation
-
-
表 1 西安地区门诊和体检人群Hp感染的基本情况
例(%) 基本情况 例数 阳性(n=3255) 阴性(n=6761) χ2 P 年龄/岁 < 18(少年) 563 0 563(100.00) 18~40(青年) 3318 876(26.40) 2442(73.60) 790.791 ＜0.001 41~65(中年) 4069 1252(30.77) 2817(69.23) ≥66(老年) 2066 1127(54.55) 939(45.45) 性别 男 4632 1753(37.85) 2879(62.15) 112.324 ＜0.001 女 5384 1502(27.90) 3882(72.10) 民族 汉族 9703 3130(32.26) 6573(67.74) 回族 130 63(48.46) 67(51.54) 满族 98 38(38.76) 60(61.24) 20.145 ＜0.001 维吾尔族 57 13(22.81) 44(77.19) 藏族 28 11(39.29) 17(60.71) 婚姻 单身 2614 868(33.21) 1746(66.79) 0.808 0.369 已婚 7402 2387(32.25) 5015(67.75) 居住地区 农村 4445 1753(39.44) 2692(60.56) 175.438 ＜0.001 城市 5571 1502(26.96) 4069(73.04) 职业 公职人员 602 94(15.61) 408(84.39) 教师 242 31(12.81) 311(87.19) 工人 885 376(42.49) 509(57.51) 农民 4232 1885(44.54) 2353(55.46) 687.177 ＜0.001 学生 1261 250(19.83) 1011(80.17) 医护人员 408 63(15.44) 345(84.56) 服务人员 955 243(25.45) 706(74.55) 自由职业 1431 313(21.87) 1118(78.13) 
下载: 导出CSV
表 2 西安地区门诊和体检人群Hp感染的单因素分析
例(%) 危险因素 例数 阳性(n=3255) 阴性(n=6761) χ2 P 消化系统症状 有 5011 1815(36.22) 3196(63.78) 63.338 ＜0.001 无 5005 1440(28.77) 3565(71.23) BMI 0~18.4(过轻) 438 376(85.84) 62(14.16) 18.5~23.9(正常) 7011 501(7.15) 6510(92.85) 6871.058 ＜0.001 24.0~27.9(超重) 1002 875(87.43) 127(12.57) ≥28.0(肥胖) 1565 1502(95.97) 63(4.03) 胃镜报告 有 176 46(26.14) 130(73.86) 3.305 0.069 无 9840 3209(32.61) 6631(67.39) 不洁饮食史 有 3318 2629(79.23) 689(20.77) 4940.423 ＜0.001 无 6698 626(9.35) 6072(90.65) 吸烟史 有 3380 1565(46.30) 1815(53.70) 443.126 ＜0.001 无 6636 1690(25.47) 4946(74.53) 饮酒史 有 2754 1502(54.54) 1252(45.46) 841.173 ＜0.001 无 7262 1753(24.14) 5509(75.86) Hp感染家族史 有 2066 1064(51.50) 1002(48.50) 428.255 ＜0.001 无 7950 2191(27.56) 5759(72.44) 冠心病史 有 876 376(42.92) 500(57.08) 47.553 ＜0.001 无 9140 2879(31.50) 6261(68.50) 糖尿病史 有 1121 315(28.10) 706(71.90) 1.404 0.236 无 8895 2940(33.05) 6055(66.95)
下载: 导出CSV
表 3 赋值表
因素 赋值 年龄 < 18(少年)=1，18~40(青年)=2，41~65(中年)=3，≥66(老年)=4 性别 女=0，男=1 民族 汉族=0，回族、满族、维吾尔族、藏族=1 居住地区 农村=0，城市=1 职业 公职人员、教师、医护人员=1，工人、农民、服务人员=2，学生、自由职业=3 消化系统症状 无=0，有=1 BMI 0~18.4(过轻)=1，18.5~24.0(正常)=2，24.1~28.0(超重)=3，≥28.1(肥胖)=4 不洁饮食史 无=0，有=1 吸烟史 无=0，有=1 饮酒史 无=0，有=1 Hp感染家族史 无=0，有=1 冠心病史 无=0，有=1
下载: 导出CSV
表 4 Hp感染危险因素的logistic回归分析
高危因素 β SE Wald χ2 P OR 95%CI 年龄 -0.135 0.601 0.050 0.822 0.874 0.269~2.836 性别 0.882 1.322 0.445 0.505 2.416 0.181~32.226 民族 -2.612 2.523 1.073 0.300 0.073 0.001~10.295 居住地区 2.635 1.218 4.682 0.030 13.945 1.282~151.700 职业 0.625 0.888 0.495 0.482 1.869 0.328~10.659 消化系统症状 3.818 1.565 5.950 0.015 45.526 2.118~978.802 BMI 4.351 1.112 15.306 ＜0.001 77.586 8.771~686.298 不洁饮食史 4.529 1.252 13.076 ＜0.001 92.624 7.957~1078.245 吸烟史 -1.699 1.769 0.922 0.337 0.183 0.006~5.868 饮酒史 4.958 2.036 5.929 0.015 142.319 2.631~7699.004 Hp感染家族史 2.374 1.108 4.587 0.032 10.735 1.223~94.211 冠心病史 -2.306 2.050 1.266 0.261 0.100 0.002~5.538
下载: 导出CSV
-
[1] Cho J, Prashar A, Jones L, et al. Helicobacter pylori Infection[J]. Gastroenterol Clin, 2021, 50(2): 261-282. doi: 10.1016/j.gtc.2021.02.001
[2] Park JS, Jun JS, Seo JH, et al. Changing prevalence of Helicobacter pylori infection in children and adolescents[J]. Clin Exp Pediatr, 2021, 64(1): 21-25. doi: 10.3345/cep.2019.01543
[3] 张万岱, 胡伏莲, 萧树东, 等. 中国自然人群幽门螺杆菌感染的流行病学调查[J]. 现代消化及介入诊疗, 2010, 15(5): 265-270. doi: 10.3969/j.issn.1672-2159.2010.05.001
[4] Liu W, Sun Y, Yuan Y. Analysis of serum gastrin-17 and Helicobacter pylori antibody in healthy Chinese population[J]. J Clin Lab Anal, 2020, 34(12): e23518.
[5] Zhu HM, Li BY, Tang Z, et al. Epidemiological investigation of Helicobacter pylori infection in elderly people in Beijing[J]. World J Clin Cases, 2020, 8(11): 2173-2180. doi: 10.12998/wjcc.v8.i11.2173
[6] Mežmale L, Polaka I, Rudzite D, et al. Prevalence and Potential Risk Factors of Helicobacter pylori Infection among Asymptomatic Individuals in Kazakhstan[J]. Asian Pac J Cancer Prev, 2021, 22(2): 597-602. doi: 10.31557/APJCP.2021.22.2.597
[7] Zamani M, Ebrahimtabar F, Zamani V, et al. Systematic review with meta-analysis: the worldwide prevalence of Helicobacter pylori infection[J]. Aliment Pharmacol Ther, 2018, 47(7): 868-876. doi: 10.1111/apt.14561
[8] Argueta EA, Moss SF. The prevention of gastric cancer by Helicobacter pylori eradication[J]. Curr Opin Gastroenterol, 2021, 37(6): 625-630. doi: 10.1097/MOG.0000000000000777
[9] Wu Y, Su T, Zhou X, et al. Awareness and attitudes regarding Helicobacter pylori infection in Chinese physicians and public population: A national cross-sectional survey[J]. Helicobacter, 2020, 25(4): e12705.
[10] Bonilla S, Mitchell PD, Mansuri I. Low Adherence to Society Guidelines for the Management of Helicobacter pylori Among Pediatric Gastroenterologists[J]. J Pediatr Gastroenterol Nutr, 2021, 73(2): 178-183.
[11] Nekaka R, Oboth P, Nteziyaremye J, et al. Sero prevalence and factors associated with Helicobacter pylori infection in a rural population in Eastern Uganda a community cross sectional study[J]. Prim Health Care, 2021, 11(4): 1-9.
[12] Yu X, Feng D, Wang G, et al. Correlation Analysis of Helicobacter pylori Infection and Digestive Tract Symptoms in Children and Related Factors of Infection[J]. Iran J Public Health, 2020, 49(10): 1912-1920.
[13] Baradaran A, Dehghanbanadaki H, Naderpour S, et al. The association between Helicobacter pylori and obesity: a systematic review and meta-analysis of case-control studies[J]. Clin Diabetes Endocrinol, 2021, 7(1): 15. doi: 10.1186/s40842-021-00131-w
[14] Azami M, Baradaran HR, Dehghanbanadaki H, et al. Association of Helicobacter pylori infection with the risk of metabolic syndrome and insulin resistance: an updated systematic review and meta-analysis[J]. Diabetol Metab Syndr, 2021, 13(1): 145. doi: 10.1186/s13098-021-00765-x
[15] Kaplan M, Tanoglu A, Duzenli T, et al. Helicobacter pylori treatment in Turkey: Current status and rational treatment options[J]. North Clin Istanb, 2020, 7(1): 87-94.
[16] Ayibatari A, Galleh P, Ogo C, et al. Prevalence of virulence genes and associated risk factors of Helicobacter pylori infection among adults in gastric cancer risk region of north central, Nigeria[J]. EJCBS, 2021, 7(6): 118-125.
[17] Yadevendra Y, Namrata J, Khemchand S. Role of iron-containing compounds in Ayurvedic medicines for the treatment of Helicobacter pylori infection[J]. Int J Tradit Complement Med, 2020, 3(4): 71-80. doi: 10.36348/sijtcm.2020.v03i04.002
[18] Wu W, Leja M, Tsukanov V, et al. Sex differences in the relationship among alcohol, smoking, and Helicobacter pylori infection in asymptomatic individuals[J]. J Int Med Res, 2020, 48(5): 300060520926036.
[19] Mukherjee S, Madathil SA, Ghatak S, et al. Association of tobacco smoke-infused water(tuibur)use by Mizo people and risk of Helicobacter pylori infection[J]. Environ Sci Pollut Res Int, 2020, 27(8): 8580-8585. doi: 10.1007/s11356-019-07543-3
[20] Yu J, Yang P, Qin X, et al. Impact of smoking on the eradication of Helicobacter pylori[J]. Helicobacter, 2022, 27(1): e12860.
[21] Lai SW. Helicobacter pylori gastric infection in patients with laryngeal cancer[J]. Eur Arch Otorhinolaryngol, 2021, 278(4): 1295. doi: 10.1007/s00405-021-06641-8
[22] Wang B, Yu M, Zhang R, et al. A meta-analysis of the association between Helicobacter pylori infection and risk of atherosclerotic cardiovascular disease[J]. Helicobacter, 2020, 25(6): e12761.
[23] Kouitcheu Mabeku LB, Noundjeu Ngamga ML, Leundji H. Helicobacter pylori infection, a risk factor for Type 2 diabetes mellitus: a hospital-based cross-sectional study among dyspeptic patients in Douala-Cameroon[J]. Sci Rep, 2020, 10(1): 12141. doi: 10.1038/s41598-020-69208-3
-