Correlation between the severity of peptic ulcer bleeding and Helicobacter pylori type / 中华消化杂志

ABSTRACT

Objective To investigate the correlation between the severity of peptic ulcer bleeding (PUB) and the serum antibody typing of Helicobacter pylori (H.pylori).Methods From January 1, 2009 to December 31, 2018, at Guangzhou First People's Hospital, 1 444 patients diagnosed with PUB and received H.pylori serum antibody test at the same time were enrolled and divided into high-risk group (324 cases) and low-risk group ( 1 120 cases ) according to Forrest classification , and according to recurrent bleeding , the patients were divided into recurrent bleeding group (32 cases) and non-rebleeding group (1 412 cases).Serum H.pylori specific antibodies cytotoxin-associated gene A (CagA), vacuolating cytotoxin A (VacA) and urease were detected by protein array .The correlation between H.pylori positive rate, H.pylori type, PUB and rebleeding were analyzed .Chi-square test and logistic regression analysis were used for statistical analysis . Results Among 1 444 PUB patients, there were 709 patients with gastric ulcer bleeding ( GUB) and 735 patients with duodenal ulcer bleeding ( DUB).Previous history of peptic ulcer disease ( odds ratio (OR)＝ 1.501, P＝0.006), the maximum diameter of ulcer over 2 cm (OR＝2.484, P?0.01) and H.pylori infection (OR＝1.508, P＝0.005) were independent risk factors of the severity of PUB .The total H.pylori positive rate was 68.49%(989/1 444), H.pylori type Ⅰwas the main type.Of which, 61.34%(549/895) were CagA and VacA double positive strains , 31.73%(284/895) were VacA single positive bacteria and CagA single positive bacteria was only 6.93%(62/895).The positive rate of H.pylori of high-risk group was higher than that of low-risk group (75.31%, 244/324 vs.66.52%, 745/1 120), and the difference was statistically significant (χ2 ＝8.999, P ＝0.004).In addition, the more serious Forrest classification , the higher the detection rate of H.pylori, and the difference was statistically significant (χ2 ＝11.840, P＝0.037).There was no significant difference in the positive rate of H.pylori between recurrent bleeding group and non-rebleeding group (81.25%, 26/32 vs.68.20%, 963/1 412; χ2 ＝2.469, P＞0.05).According to H.pylori antibody type, H.pylori typeⅠinfection was mainly in both high-risk group and low-risk group.The positive rate of H.pylori typeⅠstrain of high-risk group was higher than that of low-risk group (67.28%, 218/324 vs.60.45%, 677/1 120), and the difference was statistically significant ( χ2 ＝4.986, P ＝0.026).There was no statistically significant difference in the positive rate of H.pylori between GUB group and DUB group (68.41%, 485/709 vs. 68.57%, 504/735; χ2 ＝0.005, P＞0.05).Conclusions The infection of H.pylori is positively correlated with the severity of PUB, but not correlated with early ulcer rebleeding .H.pylori typeⅠis the main pathogenic strain of GUB and DUB, and CagA and VacA double positive strain is the most common strain .