Helicobacter pylori as an Initiating Factor of Complications in Patients With Cirrhosis: A Single-Center Observational Study
Helicobacter pylori as an Initiating Factor of Complications in Patients With Cirrhosis: A Single-Center Observational Study
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DOI：
10.3389/fmed.2020.00096
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发表时间：
2020-03-24
影响因子：
3.9
通讯作者：
Eldars, Waleed
中科院分区：
文献类型：
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作者：
Abdel-Razik, Ahmed;Mousa, Nasser;Eldars, Waleed
背景与目的：探讨肝硬化与幽门螺杆菌（H. pylori）是一个有争议的问题。本研究的目的是评估H。方法：对558例肝硬化患者进行为期1年的单中心前瞻性队列研究。血清C-反应蛋白（CRP）、肿瘤坏死因子-α（TNF-α）、白细胞介素-6（IL-6）、一氧化氮（NO）、血管内皮生长因子（VEGF）水平和粪便H。采用酶联免疫吸附试验（ELISA）检测幽门螺杆菌抗原。所有H. pylori进行治疗，然后随访3个月。根除H. pylori感染者随访1年。幽门螺杆菌阳性患者（48.4%）与血清CRP、TNF-α、IL-6、NO和VEGF水平升高以及静脉曲张、门脉高压性胃病、胃窦血管扩张、肝细胞癌（HCC）、自发性细菌性腹膜炎、肝性脑病、门静脉血栓形成（PVT）和肝肾综合征的发生率增加相关（均P < 0.05）。多变量分析模型显示，H。pylori是门静脉血栓形成和肝癌的独立危险因素（P = 0.043，P = 0.037）。经H. pylori感染组的各项生化指标及肝硬化并发症均显著降低（P均< 0.05）。幽门螺杆菌感染通过增加炎症标志物和血管介质。此外，根除它可以减少这些并发症的发生率。
Background and Aim: The relationship between liver cirrhosis and Helicobacter pylori (H. pylori) is a debatable matter. The aim of this study is to evaluate the possible association between H. pylori infection and liver cirrhosis.Methods: A single-center prospective cohort pilot study of 558 patients with cirrhosis was followed up for 1 year. Serum C-reactive protein (CRP), tumor necrosis factor-alpha (TNF-alpha), interleukin-6 (IL-6), nitric oxide (NO), vascular endothelial growth factor (VEGF) levels and Fecal H. pylori antigen were evaluated by enzyme-linked immunosorbent assay (ELISA). All patients with positive H. pylori were treated and then followed up for 3 months. Participants with eradicated H. pylori were followed up for one further year.Results: H. pylori-positive patients (48.4%) were associated with increased levels of serum CRP, TNF-alpha, IL-6, NO, and VEGF, as well as increased incidence of varices, portal hypertensive gastropathy, gastric antral vascular ectasia, hepatocellular carcinoma (HCC), spontaneous bacterial peritonitis, hepatic encephalopathy, portal vein thrombosis (PVT), and hepatorenal syndrome (all P < 0.05). Multivariate analysis models revealed that the presence of H. pylori was an independent risk variable for the development of portal vein thrombosis and hepatocellular carcinoma (P = 0.043, P = 0.037) respectively. After treatment of H. pylori infection, there was a significant reduction in all measured biochemical parameters and reported cirrhotic complications (all P < 0.05).Conclusion: Incidence of PVT and HCC development increased with H. pylori infection through increased inflammatory markers and vascular mediators. Moreover, its eradication may reduce the incidence of these complications.