摘要目的 探讨抗Hp治疗对2型糖尿病(T2DM)伴Hp感染患者的效果观察.方法 选取2012年4月至2016年6月我院门诊和住院患者明确诊断为T2DM伴Hp感染共112例,分别检测其三餐前血糖水平,依据三餐前空腹血糖平均值由低到高分别随机1:1分配,构成治疗组和对照组各56例,在原有控制血糖治疗及口服吗丁啉、达喜等对症处理基础上,治疗组予埃索美拉唑镁肠溶片、阿莫西林、克拉霉素、枸橼酸铋钾(口服枸橼酸铋钾时,停服达喜)四联抗Hp治疗14 d.停抗Hp治疗1个月后观察患者消化道症状,检查患者餐前、餐后血糖及HbA1c水平,半年至1年间复查电子胃镜,进行相关统计分析.结果 抗HP治疗后,治疗组患者腹痛、腹胀、反酸、暖气、腹泻/便秘等症状好转率分别为88.5％(23/26)、83.3％ (25/30)、74.1％(20/27)、83.9％(26/31)、82.6％(19/23),对照组分别为29.2％(7/24)、32.1％(9/28)、28.0％ (7/25)、30.3％(10/33)、18.2％(4/22),两组好转率比较差异均有统计学意义(x2值分别为8.06、6.62、3.92、7.65、6.66,P＜0.01或P＜0.05).对照组治疗前、后餐前空腹血糖,餐后2h血糖以及HbA1c比较差异均无统计学意义(P均＞0.05);而治疗组患者治疗前、后以上3项指标比较差异均有统计学意义(P＜0.05或P＜0.01),两组治疗后3项指标比较差异均有统计学意义(t值分别为4.07、7.85、4.16,P均＜0.05);治疗组患者治疗后胃黏膜糜烂/出血、溃疡、黏膜萎缩、异型增生好转率分别为86.2％ (25/29)、86.7％ (13/15)、77.8％(14/18)、72.7％(8/11),对照组分别为36.0％(9/16)、27.3％(3/11)、13.3％(2/15)、14.3％(1/7),两组患者胃黏膜病变各指标好转率比较差异均有统计学意义(x2值分别为6.71、4.12、4.38、3.85,P＜0.01或P＜0.05).治疗组总有效率为76.8％,对照组为32.1％,两组比较差异有统计学意义(x2=6.78,P＜0.01).结论 抗Hp治疗有利于消除T2DM伴Hp感染者消化道症状,稳定血糖水平,进一步修复胃黏膜病变,减少并发症及改善预后.

abstractsObjective To explore the clinical efficacy of anti-helicobacter pylori (HP) treatment on patients with type 2 diabetes mellitus and HP infection.Methods A total of 112 type 2 Diabetes patients were diagnosed with HP infection in Combine Traditional Chinese and Western Medicine Hospital of Taizhou from April 2012 to June 2016.These patients were divided into control and treatment group based on the preprandial blood glucose averages from lower to higher hierarchy.Thus,there were 56 patients in each of the two groups.The control group was given Motilium and Talcid for gastric symptoms in addition to anti-diabetes treatment,while the treatment was administered the same treatments as well as the quadruple anti-HP therapy (omeprazole,amoxicillin,clarithromycin and colloidal-bismuth-subcitrate,with Talcid stopped while colloidal-bismuth-subcitrate was administered).The anti-HP lasted for 14 days.The two groups were compared the gastric symptoms,the blood glucose levels,and the HbA1c one month after treatment.Half a year and one year post treatment,the two groups were compared the gastric mucus signs under gastroscopy.Results The improvement rates after treatment with the treatment group in abdominal pain,bloating,regurgitation,belching and diarrhea/constipation were 88.5％ (23/26),83.3％ (25/30),74.1％ (20/27),83.9％ (26/31),82.6％ (19/23),respectively,and with the control group being 29.2％(7/24),32.1％(9/28),28％(7/25),30.3％(10/33),18.2％ (4/22),respectively.The differences between the two groups were significant (x2=8.06,6.62,3.92,7.65,6.66,P＜0.05 or P＜0.01).The control group did not show significant changes in preprandial glucose levels,the glucose levels two hours post meals and the HbA1c(P＞0.05) while the treatment group showed statistically significant changes(P＜0.05 or P＜0.01).The differences in the three indicators after treatment between the two groups were significant (t =4.07,7.85,4.16,P＜ 0.05).The Gastric mucus signs under gastroscopy showed improvements in both groups after treatment.The improvement rates with the treatment group were 86.2％(25/29),86.7％ (13/15),77.8％ (14/18),72.7％ (8/11) respectively,with the control group being 36％ (9/16),27.3％ (3/11),13.3％ (2/15),14.3％ (1/7),respectively.The differences between the two groups were significant (x2 =6.71,4.12,4.38,3.85,P ＜ 0.05 or P＜ 0.01).The effectiveness rate,which was based on combined improvements in gastric symptoms,glucose levels and gastric mucus signs,was 76.8％ with the treatment group and 32.1％ with the control group.The difference was statistically significant (x2 =6.78,P＜0.01).Conclusion Anti-HP treatment can relieve the gastric symptoms,stabilize the glucose levels,and help to reverse the changed gastric mucus.All these can reduce the complications of the diabetes and improve the prognosis of the patients.