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)

[1]	Oudkerk M, Liu S, Heuvelmans MA, et al. Lung cancer LDCT screening and mortality reduction-evidence, pitfalls and future perspectives[J]. Nat Rev Clin Oncol, 2021, 18(3): 135-151.
[2]	Hyuna S, Jacques F, Rebecca LS, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries[J]. CA Cancer J Clin, 2021, 71(3): 209-249.
[3]	Kakinuma R, Noguchi M, Ashizawa K, et al. Natural history of pulmonary subsolid nodules: a prospective multicenter study[J]. J Thorac Oncol, 2016, 11(7): 1012-1028.
[4]	Lee HW, Jin KN, Lee JK, et al. Long-term follow-up of ground-grass nodules after 5 years of stability[J]. J Thorac Oncol, 2019, 14(8): 1370-1377.
[5]	Dai J, Yu G, Yu J. Can CT imaging features of ground-glass ocpacity predict invasiveness? A meta-analysis[J]. Thoracic Cancer, 2018, 9(4): 452-458.
[6]	Pellicano R, Ianiro G, Fagoonee S, et al. Review: Extragastric diseases and Helicobacter pylori[J]. Helicobacter, 2020, 25(Suppl 1): e12741.
[7]	Buzás GM. Helicobacter pylori and non-alcoholic fatty liver disease[J]. Minerva Gastroenterol Dietol, 2020, 66: 267-279.
[8]	Zuo ZT, Ma Y, Sun Y, et al. The protective effects of Helicobacter pylori infection on allergic asthma[J]. Int Arch Allergy Immunol, 2021, 182: 53-64.
[9]	Doulberis M, Papaefthymiou A, Polyzos SA, et al. Association between active Helicobacter pylori infection and glaucoma: A systematic review and meta-analysis[J]. Microorganisms, 2020, 8: 894.
[10]	Doulberis M, Kotronis G, Gialamprinou D, et al. Alzheimer’s disease and gastrointestinal microbiota; impact of Helicobacter pylori infection involvement[J]. Int J Neurosci, 2021, 131: 289-301.
[11]	Mounika P. Helicobacter pylori infection and risk of lung cancer: A meta-analysis[J]. Lung Cancer Int, 2013, 2013: 131869.
[12]	中华医学会呼吸病学分会肺癌学组, 中国肺癌防治联盟专家组. 肺结节诊治中国专家共识(2018年版)[J]. 中华结核和呼吸杂志, 2018, 41(10): 763-771.
[13]	Chen Y, Segers S, Blaser MJ. Association between Helicobacter pylori and mortality in the NHANES Ⅲ study[J]. Gut, 2013, 62(9): 1262-1269.
[14]	Philippou N, Koursarakos P, Anastasakou E, et al. Helicobacter pylori seroprevalence in patients with lung cancer[J]. World J Gastroenterol, 2004, 10(22): 3342-3344.
[15]	Najafizadeh K, Falah Tafti S, Shiehmorteza M, et al. H pylori seroprevalence in patients with lung cancer[J]. World J Gastroenterol, 2007, 13(16): 2349-2351.
[16]	Koshiol J, Flores R, Lam TK, et al. Helicobacter pylori seropositivity and risk of lung cancer[J]. PLoS One, 2012, 7(2): e32106.
[17]	Sun S, Schiller J, Gazdar A. Lung cancer in never smokers-a different disease[J]. Nat Rev Cancer, 2007, 7(10): 778-790.
[18]	Shi Z, Deng J, She Y, et al. Quantitative features can predict further growth of persistent pure ground-glass nodule[J]. Quant Imaging Med Surg, 2019, 9(2): 283-291.
[19]	Ece F, F Hatabay N, Erdal N, et al. Does Helicobacter pylori infection play a role in lung cancer?[J]. Respir Med, 2005, 99(10): 1258-1262.
[20]	Gocyk W, Niklifiski T, Olechnowicz H, et al. Helicobacter pylori, gastrin and cyclooxygenase-2 in lung cancer[J]. Med Sci Monit, 2000, 6(6): 1085-1092.
[21]	Behroozian R, Moradkhan E. The assessment of probable relationship between lung cancer and Helicobacter pylori infection[J]. Trop Gastroenterol, 2010, 31(1): 34-36.
[22]	Janssen-Heijnen ML, Coebergh JW. The changing epidemiology of lung cancer in Europe[J]. Lung Cancer, 2003, 41: 245-258.
[23]	Sugimoto M, Uotani T, Ichikawa H, et al. Gastroesophageal reflux disease in time covering eradication for all patients infected with Helicobacter pylori in Japan[J]. Digestion, 2016, 93(1): 24-31.
[24]	孔洋洋, 刘立新. 胃食管反流病患者幽门螺杆菌感染率的Meta分析[J/OL]. 中华消化病与影像杂志(电子版), 2017, 7(5): 205-210.
[25]	Ravelli AM, Panarotto MB, Verdoni L, et al. Pulmonary aspiration shown by scintigraphy in gastroesophageal reflux-related respiratory disease[J]. Chest, 2006, 130(5): 1520-1526.
[26]	Kim J, Lee JH, Kim Y, et al. Association between chronic obstructive pulmonary disease and gastroesophageal reflux disease: a national cross-sectional cohort study[J]. BMC Pulm Med, 2013, 13: 51.
[27]	Ates F, Vaezi MF. Insight into the relationship between gastroesophageal reflux disease and asthma[J]. Gastroenterol Hepatol (NY), 2014, 10(11): 729-736.
[28]	Lee JS, Collard HR, Anstrom KJ, et al. Anti-acid treatment and disease progression in idiopathic pulmonary fibrosis: an analysis of data from three randomised controlled trials[J]. Lancet Respir Med, 2013, 1(5): 369-376.
[29]	Linz B, Balloux F, Moodley Y, et al. An African origin for the intimate association between human and Helicobacter pylori[J]. Nature, 2007, 445: 915-918.
[30]	Kayhan B, Arasli M, Eren H, et al. Analysis of peripheral blood lymphocyte phenotypes and Th1/Th2 cytokines profile in the systemic immune responses of Helicobacter pylori infected individuals[J]. Microbiol Immunol, 2008, 52: 531-538.
[31]	Nakashima S, Kakugawa T, Yura H, et al. Identification of Helicobacter pylori VacA in human lung and its effects on lung cells[J]. Biochem Biophys Res Commun, 2015, 460(3): 721-726.
[32]	Altobelli A, Bauer M, Velez K, et al. Helicobacter pylori VacA targets myeloid cells in the gastric lamina propria to promote peripherally induced regulatory T-cell differentiation and persistent infection[J]. mBio, 2019, 10(2): e00261-219.
[33]	Gebert B, Fischer W, Weiss E, et al. Helicobacter pylori vacuolating cytotoxin inhibits T lymphocyte activation[J]. Science, 2003, 301: 1099-1102.
[34]	Luther J, Owyang SY, Takeuchi T, et al. Helicobacter pylori DNA decreases pro-inflammatory cytokine production by dendritic cells and attenuates dextran sodium sulphate-induced colitis[J]. Gut, 2011, 60(11): 1479-1486.
[35]	Duramad O, Fearon KL, Chang B, et al. Inhibitors of TLR-9 act on multiple cell subsets in mouse and man in vitro and prevent death in vivo from systemic inflammation[J]. J Immunol, 2005, 174: 5193-5200.
[36]	Samareh-Fekri M, Hashemi Bajgani SM, Shafahi A, et al. Detection of Helicobacter pylori in the bronchoalveolar lavage of patients with lung cancer using real-time PCR[J]. Jundishapur J Microbiol, 2016, 9(11): e32144.

[1]	杨友涵, 文印宪, 陈廖斌. 噬菌体用于关节假体周围感染治疗的研究进展[J]. 中华关节外科杂志(电子版), 2024, 18(01): 125-130.
[2]	钱雅君, 虞竹溪, 徐颖, 董丹江, 顾勤. 危重型新型冠状病毒感染合并侵袭性肺曲霉病的临床特征和高危因素分析[J]. 中华危重症医学杂志(电子版), 2024, 17(01): 3-9.
[3]	丁关棣, 黄云, 曹震, 刘刚. 胃癌根治术后感染性并发症预测：基于真实世界数据的Nomogram模型开发与验证[J]. 中华普外科手术学杂志(电子版), 2024, 18(03): 261-266.
[4]	方道成, 王勇, 胡媛媛. 泌尿系结石患者尿液菌谱及药敏特点分析[J]. 中华腔镜泌尿外科杂志(电子版), 2024, 18(01): 64-68.
[5]	熊欢庆, 王惠琴, 李玉娟, 刘刚, 金发光. TSPOT.TB、Genechip、AFB及其联合应用在结核病中的诊断价值[J]. 中华肺部疾病杂志(电子版), 2024, 17(01): 19-24.
[6]	陆祥, 陈卫荣. 单孔胸腔镜肺段切除术与单孔胸腔镜肺楔形切除术在直径2 cm以下肺磨玻璃结节的疗效分析[J]. 中华肺部疾病杂志(电子版), 2024, 17(01): 95-98.
[7]	陈景星, 吴建雄, 谭焯荣, 杜宁超. 肛周脓肿感染臀深筋膜致臀大肌深部脓肿一例报道[J]. 中华结直肠疾病电子杂志, 2024, 13(02): 158-161.
[8]	伍宵, 潘立, 谢理政, 茆翔. 幽门螺杆菌感染和循环miRNA变化与老年脑干出血患者应激性溃疡的关系[J]. 中华神经创伤外科电子杂志, 2024, 10(01): 42-47.
[9]	孙晓林, 潘世琴, 何宗钊, 马四清, 马琴. 化脓性链球菌感染致AIPF患者的护理一例[J]. 中华重症医学电子杂志, 2024, 10(01): 90-96.
[10]	王晶晶, 谢晖, 邓璞钰, 张晨晨, 田学, 谢云, 王瑞兰. 新型冠状病毒感染ARDS患者EIT监测下俯卧位通气成像的改变[J]. 中华重症医学电子杂志, 2024, 10(01): 31-37.
[11]	张钊龙, 郑卉, 赵丹阳, 赵悰怡, 刘之琪, 张优佳, 秦秉玉. 趋化因子CXC配体13在中枢神经系统感染中的意义及相关研究进展[J]. 中华重症医学电子杂志, 2024, 10(01): 54-59.
[12]	李浩南, 张煜彭, 付焱, 冯继伟, 刘凯, 张文凯. 缝隙连接蛋白43在肺部疾病中的研究进展[J]. 中华重症医学电子杂志, 2024, 10(01): 60-65.
[13]	张秋玥, 程羽, 牛雨田, 唐茂芝, 张克勤, 张懿, 郭亚楠, 涂增. 肾移植与人体微生态的相关性研究进展[J]. 中华临床医师杂志(电子版), 2024, 18(02): 207-213.
[14]	王瑛, 朱名超, 尹琼. 以贫血乏力为首发症状的人感染猪链球菌病一例[J]. 中华临床实验室管理电子杂志, 2024, 12(01): 43-47.
[15]	华美芳, 陈莉, 张峰林, 刘忠. 出血性脑卒中术后并发肺部感染的影响因素分析[J]. 中华脑血管病杂志(电子版), 2024, 18(02): 110-114.

阅读次数

全文

摘要

选择文件类型/文献管理软件名称

选择包含的内容

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

模态框（Modal）标题

选择文件类型/文献管理软件名称

选择包含的内容

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