HbA1c水平對2型糖尿病患者Hp根除治療預(yù)后的預(yù)測價值
發(fā)布時間：2018-09-18 13:17
【摘要】：背景與目的:幽門螺桿菌(Hp)與消化系統(tǒng)外疾病的相關(guān)性是近年來熱議的話題,其中2型糖尿病是Hp感染的危險因素等觀點被越來越多的人接受。在糖尿病患者中,并發(fā)各種感染的幾率較常人增高,這也使得糖尿病患者的既往抗生素使用率增高,隨之帶來的細(xì)菌抗生素耐藥機會也大幅度增加,最終會導(dǎo)致Hp根除失敗的幾率增加,同時血糖控制不佳的患者也伴隨著更多的并發(fā)癥和較差的疾病預(yù)后。對于這部分特殊人群的Hp根除管理,有必要制定相關(guān)指標(biāo)以指導(dǎo)有效的抗生素根除治療,從而避免一些不必要的治療失敗,這或許對延緩細(xì)菌耐藥的產(chǎn)生等方面做出貢獻(xiàn)。本研究意旨研究2型糖尿病患者長期血糖波動情況是否會預(yù)測Hp根除的預(yù)后,目的在于討論分析2型糖尿病患者糖化血紅蛋白(Hb A1c)水平對其Hp根除預(yù)后的預(yù)測價值。方法:采用前瞻性研究,收入2016年6月-2017年5月吉林大學(xué)第一醫(yī)院2型糖尿病同時感染Hp患者。進(jìn)行血漿或指尖血測定Hb A1c值及碳14呼氣實驗測定Hp感染情況。隨后所有患者統(tǒng)一采用相同的含鉍劑四聯(lián)療法進(jìn)行Hp根除治療,治療結(jié)束至少滿28天后進(jìn)行碳14呼氣實驗復(fù)查根除情況。結(jié)果:本研究共收入45例患者,男25名、女20名;治療成功28人,治療失敗17人。單因素分析性別與年齡均無顯著統(tǒng)計學(xué)意義,Hb A1c水平有顯著統(tǒng)計學(xué)意義(P0.001),多因素回歸分析顯示性別與年齡均無顯著統(tǒng)計學(xué)意義,Hb A1c水平有顯著統(tǒng)計學(xué)意義(P=0.003,OR=4.730),根據(jù)最大約登指數(shù)對應(yīng)得出最佳陽性預(yù)測值(cut-off值)分別為Hb A1c=8.5500、預(yù)測指數(shù)=0.3548。結(jié)論:1.2型糖尿病患者長期血糖波動情況是Hp根除預(yù)后的影響因素。2.高Hb A1c水平是2型糖尿病患者Hp根除失敗的危險因素。3.若2型糖尿病患者Hb A1c水平"g8.55或預(yù)測指數(shù)"g0.36,提示根除失敗風(fēng)險大,短期內(nèi)不建議進(jìn)行根除治療。
[Abstract]:Background & objective: the relationship between Helicobacter pylori (Hp) and diseases outside the digestive system is a hot topic in recent years. Type 2 diabetes mellitus is a risk factor for Hp infection and has been accepted by more and more people. In patients with diabetes, the risk of various infections is higher than that of the average person, which also increases the use of previous antibiotics in patients with diabetes, and increases the chances of bacterial antibiotic resistance. Ultimately, the chances of failure in Hp eradication are increased, and patients with poor blood glucose control are accompanied by more complications and poor prognosis. For the Hp eradication management of this special population, it is necessary to formulate relevant indicators to guide the effective antibiotic eradication therapy, so as to avoid some unnecessary failure of treatment, which may contribute to delaying the production of bacterial drug resistance and so on. The purpose of this study was to investigate whether long-term blood glucose fluctuations in type 2 diabetes can predict the prognosis of Hp eradication, and to discuss the prognostic value of glycosylated hemoglobin (Hb A1c) levels in patients with type 2 diabetes mellitus (T2DM) for Hp eradication. Methods: prospective study was used to study the patients with type 2 diabetes mellitus co-infected with Hp in the first Hospital of Jilin University from June 2016 to May 2017. Hb A 1c was measured in plasma or fingertip blood, and Hp infection was measured by carbon 14 breath test. All patients were subsequently treated with the same bismuth tetralogy for Hp eradication, and the eradication was reexamined by the carbon-14 breath test at least 28 days after the end of the treatment. Results: a total of 45 patients, 25 males and 20 females, were successfully treated and 17 failed. There was no significant difference between sex and age in univariate analysis. There was significant statistical significance in HbA1c level (P0.001). Multivariate regression analysis showed that there was no significant statistical significance between sex and age (P0.003 OR4.730). The best positive predictive value (cut-off) for the maximum Jorden index pair was Hb A1c0. 5500, and the predictive index was 0. 3548. Conclusion the long-term blood glucose fluctuation in type 1.2 diabetes mellitus is an important factor in the prognosis of Hp eradication. High Hb A1c level is a risk factor for failure of Hp eradication in type 2 diabetic patients. If Hb A1c level "g8.55 or predictive index" g0.36 in type 2 diabetic patients, the risk of eradication failure is high, and eradication therapy is not recommended in the short term.
【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R587.1;R573
本文編號：2248036
[Abstract]:Background & objective: the relationship between Helicobacter pylori (Hp) and diseases outside the digestive system is a hot topic in recent years. Type 2 diabetes mellitus is a risk factor for Hp infection and has been accepted by more and more people. In patients with diabetes, the risk of various infections is higher than that of the average person, which also increases the use of previous antibiotics in patients with diabetes, and increases the chances of bacterial antibiotic resistance. Ultimately, the chances of failure in Hp eradication are increased, and patients with poor blood glucose control are accompanied by more complications and poor prognosis. For the Hp eradication management of this special population, it is necessary to formulate relevant indicators to guide the effective antibiotic eradication therapy, so as to avoid some unnecessary failure of treatment, which may contribute to delaying the production of bacterial drug resistance and so on. The purpose of this study was to investigate whether long-term blood glucose fluctuations in type 2 diabetes can predict the prognosis of Hp eradication, and to discuss the prognostic value of glycosylated hemoglobin (Hb A1c) levels in patients with type 2 diabetes mellitus (T2DM) for Hp eradication. Methods: prospective study was used to study the patients with type 2 diabetes mellitus co-infected with Hp in the first Hospital of Jilin University from June 2016 to May 2017. Hb A 1c was measured in plasma or fingertip blood, and Hp infection was measured by carbon 14 breath test. All patients were subsequently treated with the same bismuth tetralogy for Hp eradication, and the eradication was reexamined by the carbon-14 breath test at least 28 days after the end of the treatment. Results: a total of 45 patients, 25 males and 20 females, were successfully treated and 17 failed. There was no significant difference between sex and age in univariate analysis. There was significant statistical significance in HbA1c level (P0.001). Multivariate regression analysis showed that there was no significant statistical significance between sex and age (P0.003 OR4.730). The best positive predictive value (cut-off) for the maximum Jorden index pair was Hb A1c0. 5500, and the predictive index was 0. 3548. Conclusion the long-term blood glucose fluctuation in type 1.2 diabetes mellitus is an important factor in the prognosis of Hp eradication. High Hb A1c level is a risk factor for failure of Hp eradication in type 2 diabetic patients. If Hb A1c level "g8.55 or predictive index" g0.36 in type 2 diabetic patients, the risk of eradication failure is high, and eradication therapy is not recommended in the short term.
【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R587.1;R573
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