有消化道症状儿童幽门螺旋杆菌现症感染的调查

Investigation of current infection with Helicobacter pylori in children with gastrointestinal symptoms

摘要:

目的：了解有消化道症状的儿童幽门螺杆菌（H. pylori）现症感染状态，并调查H. pylori感染的危险因素。方法：选择有上消化道症状的376例患儿进行胃镜检查，同时取3块胃黏膜分别作快速尿素酶及病理组织学检查。部分患儿行13C-尿素呼气试验。上述3种方法中2项或2项以上阳性者诊断为H. pylori感染。同时对患儿居住环境、家庭经济状况、父母文化程度、消化道疾病家族史进行问卷调查。结果：376例患儿中，H. pylori现症感染率为44.9%（169例）。男女H. pylori感染率差异无统计学意义（P>0.05）。3岁~、8岁~、13~16岁年龄组H. pylori阳性率分别为39.5%（47/119）、41.0%（55/134）、54.5% (67/123），不同年龄组间患儿H. pylori感染率差异有统计学意义（χ2=6.76，P<0.05）。儿童全托及中小学生寄宿、集体居住及用餐者H. pylori阳性率高于非集体居住及用餐者（53.6% vs 40.6%, P<0.05）。家庭经济收入高者H. pylori阳性率低于中低收入者（36.9% vs 48.3%，P<0.05）。父母文化程度高者H. pylori阳性率低于父母文化程度较低者（39.5% vs 50.8%，P<0.05）。有胃炎或消化性溃疡病家族史者H. pylori感染率高于无家族史者（52.9% vs 41.2%，P<0.05）。结论：随着年龄的增长，H. pylori感染率逐渐增加。集体居住、共同用餐、家庭低收入、父母受教育程度低以及有上消化道疾病家族史的患儿有较高的H. pylori感染率，因此以上因素是儿童感染H. pylori的危险因素。

Abstract:

OBJECTIVE: To investigate current infection with Helicobacter pylori (H. pylori) and related risk factors in children with gastrointestinal symptoms. METHODS: A total of 376 children with upper gastrointestinal symptoms were examined by gastroscopy. Three pieces of gastric mucosa were sampled for rapid urease test and pathohistological examination. Some children received 13C-urea breath test. Children with two or more positive results were diagnosed with H. pylori infection. A questionnaire on living environment, family economic status, parents’ education level and family history of gastrointestinal diseases was completed for all children. RESULTS: The H. pylori infection rate was 44.9% (169/376) in children with upper gastrointestinal symptoms. There was no statistical difference in the infection rate between males and females (P>0.05). The H. pylori infection rates in the 3 to 7-year old, 8 to 12-year old and 13 to 16-year-old children were 39.5% (47/119), 41.0% (55/134), and 54.5% (67/123) respectively, with significant differences between different age groups (χ2 = 6.76, P<0.05). The H. pylori positive rate was significantly higher in children who were in full-time nursery or collective living and dining than in those who were not (53.6% vs 40.6%; P<0.05). The H. pylori positive rate in high-income families was lower than that in middle to low-income families (36.9% vs 48.3%; P<0.05). In addition, the H. pylori positive rate in children with well-educated parents was lower than in those with parents who had not received higher education (39.5% vs 50.8%; P<0.05). The H. pylori infection rate in children with a family history of digestive disease was significantly higher than in those without family history of gastrointestinal diseases (52.9% vs 41.2%; P<0.05). CONCLUSIONS: The infection rate increases with age and is higher in children who are in collective living and dining, come from low income family, have parents who have not received higher education and have a family history of upper gastrointestinal diseases.