幽門桿菌除菌患者罹患心腦血管疾病風險的研究

The Study of Patients with Helicobacter Pylori Eradication and Risk of Cardiovascular and Cerebrovascular Disease

陳宏昇(Hung-Sheng Chen)

指導教授 ： 楊哲銘

臺北醫學大學/公共衛生暨營養學院/醫務管理學研究所/碩士(2012年)

https://doi.org/10.6831/TMU.2012.00055

摘要

幽門螺旋桿菌 (Helicobacter Pylori)，據估計全世界約有超過一半的成年人感染過此菌，目前的研究證實和胃潰瘍，十二指腸潰瘍，以及慢性胃炎甚至胃癌的關聯性極為密切，清除此菌有其絕對重要性。越來越多的研究顯示，幽門桿菌的感染也可能影響人體其他器官系統造成疾病。國外的研究探討了幽門桿菌和腦中風及心肌梗塞的關係，但結論呈現正反兩極的結果。在西方國家，毒力強的CagA陽性菌株盛行率約在六成左右，台灣地區CagA的存在則近乎百分之百。由於腦血管中風和急性冠狀動脈症候群都是足以致命的重症，因此本研究希望藉由全民健保資料庫的資料來探討幽門桿菌的早除菌是否能降低這兩種大血管性疾病的風險。
本研究結果發現早殺菌組與晚殺菌組的疾病風險分佈情形，在晚殺菌組的中風風險顯著較早殺菌組高，晚殺菌組發生比例為10.3%，早殺菌組為5.1%。其中，出血性中風、缺血性中風與無法辨識的中風發生比例亦顯著較早殺菌組高；晚殺菌組的出血性中風、缺血性中風及無法辨識的中風各佔3.1%、7.7%及3.1%，早殺菌組則各為1.0%、3.9%及1.0%。同樣在急性冠狀動脈症候群中，晚殺菌組的風險顯著較早殺菌組間高，急性或亞急性缺血性心臟病及各類型的心絞痛發生比例亦顯著較早殺菌組高。早殺菌組之追蹤期顯著較晚殺菌組長。晚殺菌組發生中風的平均存活時間為56.08個月，早殺菌組為58.26個月。晚殺菌發生急性冠狀動脈症候群的平均存活時間為55.99個月，早殺菌組為59.92個月。
晚殺菌的中風、急性冠狀動脈症候群的發生率高於早殺菌組。晚殺菌組中風的每千人年發生率為25.27，早殺菌組為12.09。晚殺菌組急性冠狀動脈症候群的每千人年發生率為24.40，早殺菌組為14.47。幽門桿菌晚殺菌者較早殺菌患者發生中風的機率高出2.113倍；發生急性冠狀動脈症候群的機率高出1.776倍。
經過複回歸分析，校正了性別、年齡、投保薪資、醫院層級以及各項共病後，僅在中風(出血性中風、其他中風)的發生上在兩組間具有顯著的統計差異，而其中缺血性中風的p值(0.0514)已相當接近顯著水準(α=0.05)，殺菌時機對缺血性中風的發生仍不可忽視。急性冠狀動脈症候群的發生情形經由回歸校正後，殺菌時機(早殺菌與晚殺菌)的影響則不如高血脂與冠狀動脈心臟病的影響，因此消弱了在統計上的顯著性。
根據本研究的回歸分析結果，殺菌時機(早殺菌與晚殺菌)對中風的影響具統計上的顯著差異，然而對急性冠狀動脈症候群的影響較不顯著。

關鍵字

幽門桿菌除菌 ； 心腦血管疾病風險

並列摘要

It has been estimated that over than half of the adult population in the world have been infected by Helicobacter Pylori (HP). Current study has proved the extremely close association with gastric ulcer, duodenal ulcer, chronic gastritis and gastric cancer, shows the necessary importance to eradicate HP. More and more studies display that HP infection can also affect other human organ system and create disease. Foreign research has studied the relationship between HP and brain stroke and myocardial infarction, but the conclusion shows positive and negative results. In western countries, the prevalence of virulent CagA strain is around 60%, however; the prevalence shows nearly 100% in Taiwan. Brain stroke and acute coronary syndrome are acute fetal disease. The purpose of our study is mainly to explore whether early HP eradication could lower the risk of these two kinds of macrovascular disease.
Our study is based on the resource offered by National Health Insurance database and our results show the percentage of disease risks between early HP eradication cohorts and late HP eradication cohorts. The risk of stroke in late eradication group is higher than early eradication group. The late eradication group presents 10.3% and early eradication group is 5.1%. Among them, hemorrhagic stroke, ischemic stroke and other unidentified stroke have also shown higher risk than the group of early eradication.. The occurrence of late eradication group represents 3.1% in hemorrhagic stroke, 7.7% in ischemic stroke and 3.1% in other unidentified stroke ; while the groups of early eradication present 1.0%, 3,9% and 1.0% respectively. Same results were found in acute coronary syndrome. Late eradication group has higher risk for acute or subacute ischemic heart disease and different kinds of angina pectoris than that of early eradication. The tracking period of early eradication group is longer than late eradication group. The mean survival period of strokes is 56.08 months for late eradication group while early eradication is 58.26 months. The mean survival period of acute coronary syndrome is 55.99 months for late eradication group and 59.92 months for early eradication group.
The incidence of stroke for late eradication group is higher than that of early eradication group. In the late eradication group, the incidence is 25.27 per 1000 person-year, and 12.09 in early eradication group. The incidence of acute coronary syndrome for late eradication group is 24.40 per 1,000 person-year while 14.47 for early eradication patients. The probability of stroke is 2.113 times higher in late eradication group and the probability of acute coronary syndrome is 1.776 times higher in late eradication group.
After Multiple Regression Analysis, with correction of sex, age, insured salary, medical treatment hospital level and diverse com-morbidities, it shows significant statistical difference between two groups in only strokes (hemorrhagic stroke and other unidentified stroke) . And the p-value of ischemic stroke (0.0514) is approaching standard (α=0.05).Timing of HP eradication for ischemic stroke could still not be ignored. After regression analysis correction, the incidence of acute coronary syndrome shows that timing of HP eradication ( Early or Late) having less influence than hyperlipidemia and coronary heart disease. Therefore; it weakened statistical significance.
According to the results of regression analysis, timing of HP eradication shows impacts over stroke incidence with statistical significance, but poses less prominent influence for acute coronary syndrome.

並列關鍵字

Helicobacter pylori eradication ； Risk of Cardiovascular and

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