肺磨玻璃结节与幽门螺杆菌感染的相关性研究

doi:10.3877/cma.j.issn.2095-2015.2024.03.015

目的

探讨上海地区体检人群中肺磨玻璃结节与幽门螺杆菌感染之间的关系。

方法

选取2021年1月至12月在复旦大学附属华东医院体检中心接受肺CT和¹³C呼气检查的体检人员42 318例，分为肺磨玻璃结节组和无结节组，采用独立样本t检验、Mann-Whitney U检验、卡方检验分析两组间肿瘤标志物等指标和幽门螺杆菌阳性率的差异；采用Logistic回归分析肺磨玻璃结节与幽门螺杆菌阳性的相关性。

结果

肺磨玻璃结节的发生率女性高于男性（20.67%比14.43%），幽门螺杆菌阳性率男性高于女性（26.89%比20.66%），肺磨玻璃结节组的幽门螺杆菌阳性率低于无结节组（22.33%比24.15%），差异均有统计学意义。进一步分析提示肺磨玻璃结节组的年龄、NSE、CA199、AFP高于无结节组；男性比例、体重指数、白细胞、血红蛋白、鳞状细胞癌抗原、癌胚抗原低于无结节组，差异均有统计学意义。Logistic回归分析显示调整混杂因素后肺磨玻璃结节与幽门螺杆菌阳性呈显著负相关（OR=0.863，P<0.001）。

结论

肺磨玻璃结节的形成是多种因素共同作用的结果，而幽门螺杆菌感染可能对肺磨玻璃结节的发生有一定的保护作用。

关键词: 肺磨玻璃结节, 螺杆菌，幽门, 感染, 负相关性

Objective

To investigate the relationship between pulmonary ground-glass nodule (GGN) and Helicobacter pylori (Hp) infection in the physical examination population in Shanghai area.

Methods

A total of 42318 subjects were included who underwent lung CT examination and ¹³C urea breath test (UBT) at the health examination center of Huadong Hospital Affiliated to Fudan University from January 2021 to December 2021. The subjects were divided into GGN and non-GGN groups, the differences of tumor markers and Hp positive rate between the two groups were analyzed using independent sample t test, Mann-Whitney U test and Chi-squared test. The association between GGN and Hp positive was analyzed by Logistic regression.

Results

The proportion of GGN positive subjects was higher in females than in males (20.67% vs. 14.43%), and the Hp positive rate was higher in males than in females (26.89% vs. 20.66%). The Hp positive rate in the GGN group was lower than that in the non-GGN group (22.33% vs. 24.15%). The differences were all statistically significant. The age, NSE, CA199, AFP were significantly higher in the GGN group than those in the non-GGN group. The male proportion, body mass index, white blood cell, hemoglobin, squamous cell carcinoma antigen and carcinoembryonic antigen were significantly lower in the GGN group than those in the non-GGN group. Logistic regression analysis also showed a significantly negative correlation between GGN and Hp positive after adjusting for confounding factors (OR=0.863, P<0.001).

Conclusion

The formation of GGN is associated with many risk factors, and Hp infection may have a protective effect on the occurrence of GGN.

Key words: Pulmonary ground-glass nodule, Helicobacter pylori, Infection, Negative correlation

表1 肺磨玻璃结节组和无结节组一般资料、血液指标和Hp阳性率的比较（n=22 674）

组别	例数	年龄[岁,M(Q1,Q3)]	性别[男性例数(%)]	BMI(kg/m²,±s)	WBC(10⁹/L,±s)	Hb(g/L,±s)	NSE(μg/L,±s)
结节组	3976	43.00(36.00,54.00)	1756(44.20%)	23.87±3.39	6.33±1.51	144.73±15.93	13.30±3.90
无结节组	18698	42.00(35.00,53.00)	10224(54.70%)	24.22±3.48	6.40±1.52	147.26±15.82	13.15±3.77
t/χ²/Z值		-5.29	145.47	5.96	2.67	9.17	-2.07
P值		<0.001	<0.001	<0.001	0.008	<0.001	0.039
组别	例数	CY21-1[μg/L,M(Q1,Q3)]	SCC[μg/L,M(Q1,Q3)]	CA199[ku/L,M(Q1,Q3)]	CEA[μg/L,M(Q1,Q3)]	AFP[μg/L,M(Q1,Q3)]	CA724[μg/L,M(Q1,Q3)]	Hp阳性[例(%)]
结节组	3976	2.13(1.63,2.85)	0.30(0.21,0.47)	8.11(5.32,12.63)	1.77(1.24,2.52)	4.05(3.19,5.24)	2.10(1.16,4.44)	864(21.73)
无结节组	18698	2.15(1.63,2.89)	0.31(0.21,0.48)	7.85(5.07,12.15)	1.80(1.24,2.59)	3.99(3.12,5.13)	2.16(1.16,4.42)	4373(23.39)
t/χ²/Z值		-0.69	-2.64	-3.35	-2.01	-3.39	-0.72	5.07
P值		0.485	0.008	<0.001	0.045	<0.001	0.471	0.024

表1 肺磨玻璃结节组和无结节组一般资料、血液指标和Hp阳性率的比较（n=22 674）

组别	例数	年龄[岁,M(Q1,Q3)]	性别[男性例数(%)]	BMI(kg/m²,±s)	WBC(10⁹/L,±s)	Hb(g/L,±s)	NSE(μg/L,±s)
结节组	3976	43.00(36.00,54.00)	1756(44.20%)	23.87±3.39	6.33±1.51	144.73±15.93	13.30±3.90
无结节组	18698	42.00(35.00,53.00)	10224(54.70%)	24.22±3.48	6.40±1.52	147.26±15.82	13.15±3.77
t/χ²/Z值		-5.29	145.47	5.96	2.67	9.17	-2.07
P值		<0.001	<0.001	<0.001	0.008	<0.001	0.039
组别	例数	CY21-1[μg/L,M(Q1,Q3)]	SCC[μg/L,M(Q1,Q3)]	CA199[ku/L,M(Q1,Q3)]	CEA[μg/L,M(Q1,Q3)]	AFP[μg/L,M(Q1,Q3)]	CA724[μg/L,M(Q1,Q3)]	Hp阳性[例(%)]
结节组	3976	2.13(1.63,2.85)	0.30(0.21,0.47)	8.11(5.32,12.63)	1.77(1.24,2.52)	4.05(3.19,5.24)	2.10(1.16,4.44)	864(21.73)
无结节组	18698	2.15(1.63,2.89)	0.31(0.21,0.48)	7.85(5.07,12.15)	1.80(1.24,2.59)	3.99(3.12,5.13)	2.16(1.16,4.42)	4373(23.39)
t/χ²/Z值		-0.69	-2.64	-3.35	-2.01	-3.39	-0.72	5.07
P值		0.485	0.008	<0.001	0.045	<0.001	0.471	0.024

表2 肺磨玻璃结节风险因素的多因素Logistic回归分析（n =22320）

项目	模型一[OR值(95% CI)]	模型二[OR值(95% CI)]
Hp	0.814^*(0.745~0.889)	0.863^*(0.789~0.945)
性别		0.510^*(0.471~0.553)
年龄(18~30岁=1)
31~45岁		1.922^*(1.660~2.225)
46~60岁		2.339^*(2.005~2.727)
>60岁		2.393^*(2.021~2.834)
BMI		0.971^*(0.959~0.982)
NSE		1.030^*(1.020~1.040)
AFP		1.056^*(1.035~1.077)

表2 肺磨玻璃结节风险因素的多因素Logistic回归分析（n =22320）

项目	模型一[OR值(95% CI)]	模型二[OR值(95% CI)]
Hp	0.814^*(0.745~0.889)	0.863^*(0.789~0.945)
性别		0.510^*(0.471~0.553)
年龄(18~30岁=1)
31~45岁		1.922^*(1.660~2.225)
46~60岁		2.339^*(2.005~2.727)
>60岁		2.393^*(2.021~2.834)
BMI		0.971^*(0.959~0.982)
NSE		1.030^*(1.020~1.040)
AFP		1.056^*(1.035~1.077)

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Study on the correlation between pulmonary ground-glass nodules and Helicobacter pylori infection

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Study on the correlation between pulmonary ground-glass nodules and Helicobacter pylori infection