中老年人群幽门螺杆菌感染对非酒精性脂肪肝及冠状动脉粥样硬化影响的关联性分析

doi:10.3877/cma.j.issn.2095-2015.2024.02.007

目的

评估中老年人群幽门螺杆菌（Hp）感染对非酒精性脂肪肝（NAFLD）及冠状动脉粥样硬化（CA）的影响及相关性分析。

方法

选取2018年8月至2022年7月于上海中医药大学附属曙光医院健康体检的中老年受检者234例作为研究对象，根据是否存在Hp感染，将受检者分为Hp未感染组和Hp感染组。比较两组相关临床资料、脂肪肝水平、冠状动脉钙化水平和血液生化指标水平；通过Logistic多因素回归分析，探究NAFLD及CA与Hp感染的关系；通过Spearman检验探究NAFLD及CA的相关性。

结果

Hp感染组受检者体重指数（BMI）、年龄、高血压比例、糖尿病比例、高脂血症比例、血糖、丙氨酸氨基转移酶（ALT）、天冬氨酸氨基转移酶（AST）、总胆红素（TBiL）、直接胆红素（DBiL）、总胆固醇（TC）、三酰甘油（TG）、低密度脂蛋白（LDL）、肿瘤坏死因子-α（TNF-α）、白细胞介素（IL）-6和IL-12显著高于Hp未感染组（P<0.05），高密度脂蛋白（HDL）和IL-10显著低于Hp未感染组（P<0.05）；Hp感染组NAFLD及CA的发病率和严重程度显著高于Hp未感染组（P<0.05）。多因素Logistic回归分析显示，BMI、ALT、TBiL、TNF-α、IL-10、NAFLD和CA是影响受检者Hp感染的独立危险因素；Spearman检验显示，Hp感染组和未感染组的NAFLD和CA严重程度呈正相关。

结论

中老年人群Hp感染与NAFLD和CA具有较强的关联性，Hp的肝脏和心血管并发症应在临床实践中提高重视。

关键词: 幽门螺杆菌, 非酒精性脂肪肝, 冠状动脉粥样硬化, 中老年人

Objective

To evaluate the effect of Helicobacter pylori (Hp) infection on nonalcoholic fatty liver disease (NAFLD) and coronary atherosclerosis (CA) in middle-aged and elderly people and analyze the correlation.

Methods

A total of 234 middle-aged and elderly patients who underwent physical examinations between August 2018 and July 2022 were selected as the research subjects. Based on the presence of Hp infection, the subjects were divided into Hp uninfected group and Hp infected group. The clinical data, fatty liver levels, coronary artery calcification levels, and blood biochemical indicators levels between the two groups were compared. The relationship between NAFLD, CA, and Hp infection through Logistic multiple factor regression analysis was explored. The correlation between NAFLD and CA through Spearman test was explored.

Results

Body mass index (BMI), age, proportion of hypertension, proportion of diabetes, proportion of hyperlipidemia, blood glucose, alanine aminotransferase (ALT), aspartic transaminase (AST), total bilirubin (TBiL), direct bilirubin (DBiL), total cholesterol (TC), triacylglycerol (TG), low density lipoprotein (LDL), tumor necrosis factor-α (TNF-α), interleukin (IL)-6 and IL-12 in Hp infected group were significantly higher than those in Hp uninfected group, while high-density lipoprotein (HDL) and IL-10 in Hp infected group were significantly lower than those in Hp uninfected group (P<0.05). The incidence rate and severity of NAFLD and CA in Hp infection group were significantly higher than those in Hp uninfected group (P<0.05). Multivariate Logistic regression analysis showed that BMI, ALT, TBiL, TNF-α, IL-10, NAFLD, and CA were independent risk factors affecting Hp infection in subjects. Spearman test showed a positive correlation between NAFLD and CA severity in the Hp infected and non-infected groups.

Conclusion

There is a strong correlation between Hp infection and NAFLD and CA in the middle-aged and elderly population. The liver and cardiovascular complications of Hp should be given more attention in clinical practice.

Key words: Helicobacter pylori, Non alcoholic fatty liver disease, Coronary atherosclerosis, Middle aged and elderly population

表1 两组受检者的临床资料和血液生化指标的比较

组别	例数	年龄(岁,±s)	男/女(例)	体重指数(kg/m²,±s)	高血压[例(%)]	糖尿病[例(%)]	高脂血症[例(%)]	血糖(mmol/L,±s)
Hp未感染组	129	57.25±8.09	58/71	25.06±2.95	52(40.3)	49(38.0)	35(27.1)	5.82±0.51
Hp感染组	105	58.54±9.43	46/59	23.16±2.81	54(51.4)	53(50.5)	41(39.0)	6.81±0.76
t/χ²		1.278	0.055	14.649	4.824	5.798	5.211	4.021
P		0.692	0.884	0.008	0.03	0.02	0.022	0.041
组别	例数	ALB(g/L,±s)	ALT(U/L,±s)	AST(U/L,±s)	TbiL(μmol/L,±s)	DbiL(μmol/L,±s)	TC(mmol/L,±s)	TG(mmol/L,±s)
Hp未感染组	129	42.65±3.24	32.14±1.95	21.85±0.53	11.78±4.34	3.35±1.24	4.09±0.96	1.67±84.02
Hp感染组	105	40.26±2.38	43.65±2.21	31.34±0.34	15.71±4.68	5.91±1.28	5.68±1.23	2.78±87.64
t/χ²		1.048	9.342	6.340	10.324	5.357	8.325	6.672
P		0.358	0.007	0.012	0.001	0.031	0.012	0.034
组别	例数	LDL(mmol/L,±s)	HDL(mmol/L,±s)	TNF-α(pg/mL,±s)	IL-1β(μg/L,±s)	IL-6(pg/mL,±s)	IL-10(pg/mL,±s)	IL-12(pg/mL,±s)
Hp未感染组	129	2.57±2.35	1.98±0.25	24.31±6.02	0.95±0.17	5.95±4.02	11.31±4.16	42.29±9.05
Hp感染组	105	3.45±2.68	1.24±0.39	39.95±8.47	1.12±0.29	11.68±4.92	8.29±3.42	63.25±12.85
t/χ²		4.967	4.157	25.315	3.345	10.325	13.295	7.381
P		0.045	0.047	<0.001	0.116	0.011	0.006	0.024

表1 两组受检者的临床资料和血液生化指标的比较

组别	例数	年龄(岁,±s)	男/女(例)	体重指数(kg/m²,±s)	高血压[例(%)]	糖尿病[例(%)]	高脂血症[例(%)]	血糖(mmol/L,±s)
Hp未感染组	129	57.25±8.09	58/71	25.06±2.95	52(40.3)	49(38.0)	35(27.1)	5.82±0.51
Hp感染组	105	58.54±9.43	46/59	23.16±2.81	54(51.4)	53(50.5)	41(39.0)	6.81±0.76
t/χ²		1.278	0.055	14.649	4.824	5.798	5.211	4.021
P		0.692	0.884	0.008	0.03	0.02	0.022	0.041
组别	例数	ALB(g/L,±s)	ALT(U/L,±s)	AST(U/L,±s)	TbiL(μmol/L,±s)	DbiL(μmol/L,±s)	TC(mmol/L,±s)	TG(mmol/L,±s)
Hp未感染组	129	42.65±3.24	32.14±1.95	21.85±0.53	11.78±4.34	3.35±1.24	4.09±0.96	1.67±84.02
Hp感染组	105	40.26±2.38	43.65±2.21	31.34±0.34	15.71±4.68	5.91±1.28	5.68±1.23	2.78±87.64
t/χ²		1.048	9.342	6.340	10.324	5.357	8.325	6.672
P		0.358	0.007	0.012	0.001	0.031	0.012	0.034
组别	例数	LDL(mmol/L,±s)	HDL(mmol/L,±s)	TNF-α(pg/mL,±s)	IL-1β(μg/L,±s)	IL-6(pg/mL,±s)	IL-10(pg/mL,±s)	IL-12(pg/mL,±s)
Hp未感染组	129	2.57±2.35	1.98±0.25	24.31±6.02	0.95±0.17	5.95±4.02	11.31±4.16	42.29±9.05
Hp感染组	105	3.45±2.68	1.24±0.39	39.95±8.47	1.12±0.29	11.68±4.92	8.29±3.42	63.25±12.85
t/χ²		4.967	4.157	25.315	3.345	10.325	13.295	7.381
P		0.045	0.047	<0.001	0.116	0.011	0.006	0.024

表2 两组受检者非酒精性脂肪肝和冠状动脉粥样硬化严重程度的比较[例（%）]

组别	例数	非酒精性脂肪肝				冠状动脉粥样硬化
组别	例数	无	轻度	中度	重度	无	轻度	中度	重度
Hp未感染组	129	57(44.2)	38(29.5)	24(18.6)	10(7.7)	66(51.2)	33(25.5)	18(14.0)	12(9.3)
Hp感染组	105	24(22.9)	33(31.4)	28(26.7)	20(19.0)	36(34.3)	23(21.9)	26(24.8)	20(19.0)
χ²		18.442				13.993
P		<0.001				0.003

表2 两组受检者非酒精性脂肪肝和冠状动脉粥样硬化严重程度的比较[例（%）]

组别	例数	非酒精性脂肪肝				冠状动脉粥样硬化
组别	例数	无	轻度	中度	重度	无	轻度	中度	重度
Hp未感染组	129	57(44.2)	38(29.5)	24(18.6)	10(7.7)	66(51.2)	33(25.5)	18(14.0)	12(9.3)
Hp感染组	105	24(22.9)	33(31.4)	28(26.7)	20(19.0)	36(34.3)	23(21.9)	26(24.8)	20(19.0)
χ²		18.442				13.993
P		<0.001				0.003

表3 影响受检者Hp感染的多因素Logistic回归分析

变量	β	标准误	Wald χ²	P	OR	95% CI
BMI	0.634	1.102	6.337	0.026	1.238	1.116~2.368
ALT	0.908	0.729	5.648	0.030	1.968	1.438~2.529
TBiL	0.982	1.326	9.624	0.008	2.465	1.530~4.395
TNF-α	0.799	0.946	10.062	0.004	3.485	2.945~6.973
IL-10	0.519	1.062	5.946	0.035	0.735	0.327~0.824
NAFLD	0.782	1.165	7.258	0.013	1.826	1.329~3.026
CA	0.725	0.912	5.468	0.039	1.395	1.068~1.882

表3 影响受检者Hp感染的多因素Logistic回归分析

变量	β	标准误	Wald χ²	P	OR	95% CI
BMI	0.634	1.102	6.337	0.026	1.238	1.116~2.368
ALT	0.908	0.729	5.648	0.030	1.968	1.438~2.529
TBiL	0.982	1.326	9.624	0.008	2.465	1.530~4.395
TNF-α	0.799	0.946	10.062	0.004	3.485	2.945~6.973
IL-10	0.519	1.062	5.946	0.035	0.735	0.327~0.824
NAFLD	0.782	1.165	7.258	0.013	1.826	1.329~3.026
CA	0.725	0.912	5.468	0.039	1.395	1.068~1.882

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Correlation analysis of the influence of Helicobacter pylori infection on nonalcoholic fatty liver disease and coronary atherosclerosis in middle-aged and elderly people

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Correlation analysis of the influence of Helicobacter pylori infection on nonalcoholic fatty liver disease and coronary atherosclerosis in middle-aged and elderly people