Risk factor analysis of pediatric Helicobacter pylori infection of rural areas in Shaanxi Province and its correlation with chronic mesenteric lymphadenitis
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摘要: 目的 调查陕西农村地区儿童幽门螺杆菌(Helicobacter pylori，HP)感染的流行病学特征及筛选独立危险因素，并探讨HP感染与慢性肠系膜淋巴结炎(mesenteric lymphadenitis，MLN)的关系。方法 收集2020年9月—2023年10月就诊于西安交通大学第二附属医院、陕西子洲县中医院、陕西勉县中医院进行13C尿素呼气试验儿童的临床资料，完成HP感染基本情况分析、HP感染与慢性MLN患病特点分析、HP感染危险因素logistic回归分析、HP感染与慢性MLN相关性logistic回归分析。结果 本研究共纳入陕西省北、中、南部农村地区儿童709例，其中HP阳性329例，阴性380例，HP感染率为46.40%；慢性MLN患儿112例，无慢性MLN 597例，MLN患病率为15.80%。HP感染基本情况分析显示，各年龄段HP感染率比较均差异有统计学意义(均P < 0.001)，>15~18岁儿童HP感染率最高；男童HP感染率显著高于女童，差异有统计学意义(P < 0.01)；西安市农村地区儿童HP感染率显著高于榆林市及汉中市，均差异有统计学意义(均P < 0.01)；共用刷牙口杯、共用餐具、无饭前便后洗手习惯、喜食零食、直系亲属有胃肠病史及家庭人口≥4人的儿童HP感染率均显著高于无上述习惯的儿童(均P < 0.001)。HP感染与慢性MLN患病特点分析显示，HP感染患儿的白细胞计数、单核细胞计数、C反应蛋白、降钙素原、IL-6、免疫球蛋白G、补体C3、补体C4显著升高，CD3+计数、CD4+计数、CD8+计数显著降低(均P < 0.05)；紫癜患儿HP感染率显著高于贫血与口腔溃疡患儿(均P < 0.05)；HP感染患儿腹腔淋巴结最大短径、肠壁水肿及腹腔液性暗区深度显著增加(均P < 0.01)；慢性MLN患儿C反应蛋白、降钙素原、免疫球蛋白G、补体C3、补体C4、CD4+计数、CD8+计数、CD4+/ CD8+比值显著高于无慢性MLN儿童(均P < 0.05)；贫血、口腔溃疡、发育缓慢患儿的MLN患病率相当，并显著高于其他患儿，均差异有统计学意义(均P < 0.05)；慢性MLN患儿的腹腔淋巴结最大长径显著增加，高于无慢性MLN儿童，差异有统计学意义(P < 0.01)。HP感染危险因素logistic回归分析显示，性别、居住地区、共用餐具、无饭前便后洗手习惯、喜食零食、再发性腹痛及消化不良症状均为HP感染的独立危险因素(均P < 0.05)。HP感染与慢性MLN相关性的logistic回归分析显示，未校正模型HP感染与慢性MLN之间的比值比(OR)为2.324(95%CI：1.427~3.785，P < 0.001)；当校正年龄、性别、居住地区、共用刷牙口杯、共用餐具、喜食零食、恶心及呕吐症状后，OR为2.352(95%CI：1.501~3.686，P < 0.001)。结论 陕西农村地区儿童HP感染的独立危险因素为性别、居住地区、共用餐具、无饭前便后洗手习惯、喜食零食、再发性腹痛及消化不良症状。HP感染是导致陕西农村地区儿童慢性MLN的重要危险因素。Abstract: Objective To investigate the epidemiological characteristics and independent risk factors of pediatric Helicobacter pylori(HP) infection in rural areas of Shaanxi Province, and to explore the correlation between HP infection and chronic mesenteric lymphadenitis(MLN).Methods To collect clinical information from children who had 13C urea breath tests in the Second Affiliated Hospital of Xi'an Jiaotong University(Xi'an), Zizhou County Traditional Chinese Medicine Hospital(Yulin), and Mian County Traditional Chinese Medicine Hospital(Hanzhong) from September 2020 to October 2023. We completed the logistic regression analyses of risk factors for HP infection and the association between HP infection and chronic MLN, as well as the basic analyses of HP infection and the characteristics of chronic MLN.Results The study included a total of 709 rural children in the northern, central, and southern regions of Shaanxi Province, including 329 HP-positive cases and 380 HP-negative cases. The HP infection rate was 46.40%. There were 112 children with chronic MLN and 597 children without chronic MLN, and the prevalence of MLN was 15.80%. The basic study of HP infection revealed significant differences in HP infection rates among different age groups(all P < 0.001). The age group of > 15 to 18 years old had the greatest infection rate among the minors. The prevalence of HP infection in rural boys in Xi'an was substantially greater than that in girls(P < 0.01). Compared to Yulin and Hanzhong, the infection rate among rural children in Xi'an was also considerably higher(both P < 0.01). Children with a family size of less than four, those who shared toothbrush cups, shared tableware, did not wash their hands before and after using the restroom, enjoyed snacking, and had immediate relatives with a history of gastrointestinal illness, achieved a significantly higher rate of HP infection(all P < 0.001). Analysis of characteristics of HP infection and chronic MLN showed that children with HP had significantly higher counts of white blood cells, monocytes, C-reactive protein, procalcitonin, interleukin 6, immunoglobulin G, complement C3, complement C4, but except for CD3+count, CD4+count, and CD8+count(all P < 0.05). The HP infection rate in children with purpura was significantly higher than those with anemia and oral ulcers(all P < 0.05). In children infected with HP, there was a substantial increase in the maximal short diameter of abdominal lymph nodes, intestinal wall edema, and depth of peritoneal fluid dark regions(all P < 0.01). C-reactive protein, procalcitonin, immunoglobulin G, complement C3, complement C4, CD4+count, CD8+count, CD4+/CD8+in children with chronic MLN were significantly higher than those without MLN(all P < 0.05). The prevalences of MLN in children with anemia, oral ulcers, and slow development were equal, which were significantly higher than that in children with purpura (all P < 0.05). The maximum diameter of abdominal lymph nodes in children with chronic MLN was significantly increased(P < 0.01). Logistic regression analysis of risk factors for HP showed that gender, living area, sharing tableware, not washing hands before meals and after using the toilet, liking snacks, recurrent abdominal pain, and indigestion symptoms were all independent risk factors(all P < 0.05). Logistic regression analysis of the correlation between HP infection and chronic MLN showed that the odds ratio(OR) in the unadjusted model was 2.324(95%CI: 1.427-3.785, P < 0.001). When adjusting for age, gender, living area, sharing toothbrush cups, sharing tableware, eating snacks, nausea, and vomiting, the OR was 2.352(95%CI: 1.501-3.686, P < 0.001).Conclusion In addition, the independent risk factors for HP infection are gender, living area, sharing tableware, washing hands before meals and after using the restroom, liking snacks, recurrent abdominal pain, and indigestion symptoms in Shaanxi Province. Furthermore, HP infection is an important risk factor for chronic MLN in Shaanxi Province.
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Key words:
- Helicobacter pylori /
- children /
- mesenteric lymphadenitis /
- risk factor
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表 1 陕西农村地区儿童HP感染的基本情况
例(%) 基本情况 合计 HP阳性(n=329) HP阴性(n=380) χ2 P 年龄/岁 59.891 < 0.001 4~6 123(17.35) 39(5.50) 84(11.85) >6~9 189(26.66) 71(10.01) 118(16.64) >9~12 176(24.82) 75(10.58) 101(14.25) >12~15 97(13.68) 51(7.19) 46(6.49) >15~18 124(17.49) 93(13.12) 31(4.37) 性别 7.493 0.006 男 379(53.46) 194(27.36) 185(26.09) 女 330(46.54) 135(19.04) 195(27.50) 居住地区 12.378 0.002 榆林市(北) 203(28.63) 107(15.09) 96(13.54) 西安市(中) 326(45.98) 128(18.05) 198(27.93) 汉中市(南) 180(25.39) 94(13.26) 86(12.13) 生活习惯 共用刷牙口杯 29.582 < 0.001 是 113(15.94) 26(3.67) 87(12.27) 否 596(84.06) 303(42.74) 293(41.33) 共用餐具 40.090 < 0.001 是 589(83.07) 305(43.02) 284(40.06) 否 120(16.93) 24(3.39) 96(13.54) 饭前便后洗手 42.096 < 0.001 是 547(77.15) 290(40.90) 257(36.25) 否 162(22.85) 39(5.50) 123(17.35) 喜食零食 47.981 < 0.001 是 538(75.88) 289(40.76) 249(35.12) 否 171(24.12) 40(5.64) 131(18.48) 直系亲属有胃肠疾病史 28.520 < 0.001 是 161(22.71) 45(6.35) 116(16.36) 否 548(77.29) 284(40.06) 264(37.24) 家庭人口/人 13.469 < 0.001 ≥4 664(93.65) 320(45.13) 344(48.52) < 4 45(6.35) 9(1.27) 36(5.08) 临床症状 4.034 0.672 再发性腹痛 61(8.60) 38(5.36) 23(3.24) 黑便 3(0.42) 2(0.28) 1(0.14) 恶心 18(2.54) 13(1.83) 5(0.71) 呕吐 19(2.68) 14(1.97) 5(0.71) 消化不良 48(6.77) 35(4.94) 13(1.83) 腹泻 5(0.71) 3(0.42) 2(0.28) 湿疹 21(2.96) 11(1.55) 10(1.41) 
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表 2 HP感染与慢性MLN的患病特点
X ± S，例(%) 患病特点 HP阳性(n=329) HP阴性(n=380) P 慢性MLN(n=112) 无慢性MLN(n=597) P 检验指标 白细胞计数/(×109/L) 7.76±2.76 7.34±2.86 0.047 7.57±2.85 7.48±2.62 0.756 中性粒细胞计数/(×109/L) 4.42±2.58 4.29±2.49 0.497 4.36±2.56 4.32±2.41 0.878 淋巴细胞计数/(×109/L) 2.64±1.27 2.55±1.64 0.420 2.61±1.52 2.53±1.02 0.486 单核细胞计数/(×109/L) 0.51±0.36 0.45±0.25 0.009 0.49±0.33 0.44±0.25 0.068 中性粒细胞百分比/% 57.54±26.65 55.38±14.54 0.191 56.44±22.23 56.25±13.79 0.905 淋巴细胞百分比/% 35.49±14.25 35.42±13.59 0.947 36.44±13.13 35.29±14.07 0.423 单核细胞百分比/% 6.39±2.41 6.20±2.57 0.310 6.37±2.50 5.89±2.41 0.061 中性粒细胞/淋巴细胞比值 2.28±1.40 2.15±1.94 0.313 2.24±1.26 2.07±1.77 0.333 C反应蛋白/(mg/L) 7.26±2.61 6.08±1.02 < 0.001 8.20±3.51 6.47±1.45 < 0.001 降钙素原/(ng/mL) 0.18±0.15 0.14±0.13 < 0.001 0.19±0.15 0.13±0.09 < 0.001 IL-6/(pg/mL) 9.41±5.28 7.14±1.92 < 0.001 7.69±5.36 7.44±1.30 0.624 免疫球蛋白G/(g/L) 431.13±51.36 319.94±53.29 < 0.001 317.45±47.00 304.48±41.85 0.007 补体C3/(g/L) 58.50±8.57 47.93±6.21 < 0.001 64.36±6.45 53.49±5.98 < 0.001 补体C4/(g/L) 14.05±4.92 9.50±1.24 < 0.001 12.87±1.23 12.22±1.43 < 0.001 CD3+计数/(细胞/μL) 1 000.77±825.75 1 487.03±933.77 < 0.001 1 023.00±755.58 956.98±736.79 0.386 CD4+计数/(细胞/μL) 598.29±403.12 855.57±406.24 < 0.001 859.00±309.71 659.22±423.16 < 0.001 CD8+计数/(细胞/μL) 419.22±292.57 636.00±440.13 < 0.001 575.50±283.55 486.16±368.50 0.004 CD4+/CD8+ 1.47±0.53 1.53±0.45 0.108 1.55±0.22 1.48±0.52 0.019 合并疾病 0.045 0.024 贫血 16(2.26) 14(1.97) 4(0.56) 26(3.67) 紫癜 21(2.96) 1(0.14) 3(0.42) 19(2.68) 口腔溃疡 4(0.56) 3(0.42) 4(0.56) 3(0.42) 腐蚀性食管炎 3(0.42) 1(0.14) 2(0.28) 2(0.28) 肠梗阻 2(0.28) 1(0.14) 1(0.14) 2(0.28) 发育缓慢 5(0.71) 2(0.28) 4(0.56) 3(0.42) 腹部超声/mm 淋巴结最大长径 14.29±4.72 13.72±4.01 0.083 16.23±4.15 14.19±4.60 < 0.001 淋巴结最大短径 5.57±1.75 5.11±2.10 0.002 5.78±1.91 5.49±1.81 0.123 肠壁水肿 21.33±9.82 19.67±4.16 0.003 21.21±5.76 21.00±8.87 0.749 腹腔液性暗区深度 3.41±0.90 2.98±0.88 < 0.001 3.45±0.79 3.30±0.89 0.096 胃镜检查 0.008 0.153 食管炎 7(0.99) 6(0.85) 2(0.28) 11(1.55) 慢性浅表性胃炎 71(10.01) 95(13.40) 74(10.44) 92(12.98) 胃溃疡 2(0.28) 1(0.14) 1(0.14) 2(0.28) 十二指肠溃疡 8(1.13) 1(0.14) 4(0.56) 5(0.71) 十二指肠球炎 9(1.27) 1(0.14) 2(0.28) 8(1.13) 胆汁反流 7(0.99) 6(0.85) 3(0.42) 10(1.41)
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表 3 陕西农村地区儿童HP感染危险因素logistic回归分析
高危因素 χ2 SE Wald χ2 P OR 95%CI 年龄 -1.117 0.332 11.314 0.001 0.327 0.171~0.627 性别 0.459 0.185 6.137 0.013 1.583 1.101~2.276 居住地区 1.039 0.309 11.296 0.001 2.827 1.542~5.183 共用刷牙口杯 -1.046 0.275 14.457 < 0.001 0.351 0.205~0.602 共用餐具 1.216 0.287 17.900 < 0.001 3.375 1.921~5.929 无饭前便后洗手习惯 1.085 0.239 20.613 < 0.001 2.960 1.853~4.730 喜食零食 1.230 0.232 28.198 < 0.001 3.420 2.172~5.385 直系亲属有胃肠疾病史 -0.890 0.236 14.234 < 0.001 0.410 0.258~0.652 家庭人口≥4人 0.600 0.506 1.409 0.235 1.822 0.676~4.910 再发性腹痛 0.867 0.350 6.149 0.013 2.380 1.199~4.724 恶心 1.115 0.635 3.082 0.079 3.051 0.878~10.597 呕吐 1.251 0.676 3.425 0.064 3.495 0.929~13.154 消化不良 0.809 0.393 4.229 0.040 2.245 1.039~4.851
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表 4 HP感染与慢性MLN相关性的logistic回归分析
OR(95%CI) 13C-尿素呼气试验 模型1 模型2 模型3 模型4 HP阴性 1.000(~) 1.000(~) 1.000(~) 1.000(~) HP阳性 2.324(1.427~3.785) 2.333(1.451~3.754) 2.319(1.477~3.639) 2.352(1.501~3.686) P 0.001 < 0.001 < 0.001 < 0.001
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