Helicobacter pylori infection and the risk of acute coronary syndrome: a nationwide retrospective cohort study
Helicobacter pylori infection and the risk of acute coronary syndrome: a nationwide retrospective cohort study
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DOI：
10.1007/s10096-014-2207-7
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发表时间：
2015-01-01
影响因子：
4.5
通讯作者：
Kao, C. -H.
中科院分区：
文献类型：
--
作者：
Lai, C. -Y.;Yang, T. -Y.;Kao, C. -H.
幽门螺杆菌感染(HPI)造成了巨大的社会成本，在消化性溃疡疾病、胃癌和加速心血管疾病中具有重要的病因学意义。这项研究在一项全国性的回顾性队列研究中确定了与HPI相关的急性冠脉综合征(ACS)的风险。利用台湾国民健康保险研究资料库(NHIRD)，我们确认了1998-2010年间被诊断为HPI的患者。此外，我们从没有HPI的普通人群中随机选择了按年龄、性别和指数年进行频率匹配的非HPI对照。使用COX比例风险回归模型分析急性冠脉综合征的风险，其中包括性别、年龄和合并疾病作为变量。我们为HPI组确定了17,075名参与者，并为对照组选择了68,300名参与者。与对照组相比，HPI组患者的发病率明显升高。总体而言，HPI患者的急性冠脉综合征粗风险比是1.93倍，调整年龄、性别和合并症后的风险比是1.48倍。然而，急性冠脉综合征的总体调整危险比随着年龄的增加而增加，在不同年龄组中调整后的危险比为3.11至8.24。糖尿病、高脂血症和慢性阻塞性肺疾病等几种合并症对急性冠脉综合征的风险有协同作用。我们确定了急性冠脉综合征和合并症之间的显著关联，并为鼓励临床医生观察急性冠脉综合征相关的合并症提供了证据。
Helicobacter pylori infection (HPI) imposes substantial social costs and is of major etiological importance in peptic ulcer disease, gastric cancer, and accelerated cardiovascular diseases. This study determined the risk of acute coronary syndrome (ACS) associated with HPI in a nationwide retrospective cohort study. By using the Taiwan National Health Insurance Research Database (NHIRD), we identified patients diagnosed with HPI from 1998 to 2010. In addition, we randomly selected non-HPI controls frequency-matched by age, sex, and index year from the general population free of HPI. The risk of ACS was analyzed using Cox proportional hazards regression models in which sex, age, and comorbidities were included as variables. We identified 17,075 participants for the HPI group and selected 68,300 participants for the comparison group. The incidence rates were increased in the patients in the HPI group compared with those in the comparison group. Overall, the HPI patients exhibited a 1.93-fold high crude hazard ratio for ACS, and a 1.48-fold adjusted hazard ratio after age, sex, and comorbidities were adjusted. However, the overall adjusted hazard ratio of ACS increased with increasing age with a 3.11 to 8.24 adjusted hazard ratio among the various age groups. Several comorbidities, such as diabetes, hyperlipidemia, and COPD exhibited synergistic effects for ACS risk. We determined a significant association between ACS and comorbidities and provide evidence to encourage clinicians to observe ACS-related comorbidities.