幽门螺杆菌感染对植入药物洗脱支架急性冠状动脉综合征患者长期预后的影响

doi:10.3969/j.issn.1006-7795.2016.06.006

摘要/Abstract

摘要： 目的探讨幽门螺杆菌（Helicobacter pylori，Hp）感染和急性冠状动脉综合征（acute coronary syndrome，ACS）患者植入药物洗脱支架（drug eluting stent，DES）后长期随访心血管不良事件的关系。方法回顾性选择2010年1月1日至2012年12月31日行DES植入术的326例ACS患者。所有患者均已经进行了¹³C尿素呼气试验，高敏C反应蛋白（high sensitive C-reactive protein，hsCRP），同型半胱氨酸（homocysteine，HCY）等检查，根据Hp感染情况及是否行Hp根除治疗分为3组：无Hp感染的患者组（Hp-group，n=176），Hp阳性行根治术后转阴患者（Hp+therapy group，n=75），Hp阳性没有根除治疗患者（Hp+no therapy group，n=75）。随访5年内主要心血管不良事件（main adverse cardiovascular event，MACE）和上消化道出血（upper gastrointestinal bleeding，UGIB）发生情况。结果随访5年，结果发现Hp+no therapy患者较其他2组MACE和UGIB发生率高（P值分别为0.009和0.000）。Hp+no therapy是预测累积MACE事件（HR：2.441，95%CI：1.354~4.400，P=0.003）和UGIB（HR：5.257，95%CI：2.572~10.745，P<0.001）的独立危险因素。结论植入药物洗脱支架合并Hp感染的ACS患者有更多的MACE和UGIB发生，Hp根除治疗可以降低MACE和UGIB的发生率。

关键词: 幽门螺杆菌, 根除治疗, 急性冠状动脉综合征, 主要不良心脏事件, 远期预后

Abstract: Objective To explore the relationship between Helicobacter pylori (Hp) infection and the long-term outcome in patients with acute coronary syndrome (ACS) treated with drug-eluting stent (DES) implantation. Methods We retrospectively analyzed consecutive 326 patients who were treated with DES implantation from January 1, 2010 to December 31, 2012. Demographic data were collected and all patients underwent examination of high sensitivity C-reactive protein (hsCRP), homocysteine (HCY) and other biochemical indicators. All the patients were divided into three groups according to the result of ¹³C urea breath test. Group 1 had 176 patients without Hp infection; Group 2 had 75 patients with Hp infection with eradication therapy; and group 3, 75 patients with Hp infection without eradication therapy. We explored the correlations of Hp infection with major adverse cardiovascular event (MACE) and upper gastrointestinal bleeding (UGIB) after 5 years of follow-up using survival analysis. Results After 5 years of follow-up, we found that patients with Hp infection without therapy had more MACE and UGIB than the other two groups (P value is 0.009 and 0.000, respectively). Survival analysis showed that Hp infection was a predictor of MACE with a hazard ratio (HR) of 2.441, with 95% confidence interval (CI): 1.354-4.400, P=0.003 and UGIB with HR of 5.257, with 95% CI:2.572-10.745, P<0.001. Conclusion Patients after DES implantation with Hp infection had more MACE and UGIB after 5 years of follow-up. Hp eradication therapy maybe able to lower the rate of MACE and UGIB.

Key words: Helicobacter pylori, eradication therapy, acute coronary syndrome, major adverse cardiac events, long-term outcome

中图分类号:

王德昭, 王军, 李世敬, 陈步星. 幽门螺杆菌感染对植入药物洗脱支架急性冠状动脉综合征患者长期预后的影响[J]. 首都医科大学学报, 2016, 37(6): 746-752.

Wang Dezhao, Wang Jun, Li Shijing, Chen Buxing. Helicobacter pylori infection impact on long-term prognosis in patients implanted with drug-eluting stent with acute coronary syndrome[J]. Journal of Capital Medical University, 2016, 37(6): 746-752.

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