幽门螺杆菌感染与C-反应蛋白升高的联合作用与缺血性脑卒中预后的关系

张陈欢; 张培培; 黄萍; 吕利英; 国钰梅; 周蓦; 张永红; 许锬

doi:10.16462/j.cnki.zhjbkz.2019.06.008

幽门螺杆菌感染与C-反应蛋白升高的联合作用与缺血性脑卒中预后的关系

doi: 10.16462/j.cnki.zhjbkz.2019.06.008

张陈欢¹,
张培培²,
黄萍³,
吕利英⁴,
国钰梅⁴,
周蓦⁵,
张永红¹,
许锬^1, ,

1.
215123 苏州, 苏州大学医学部公共卫生学院流行病与卫生统计学系
2.
213000 常州, 常州市疾病预防控制中心急性传染病防控科
3.
213000 常州, 常州市中医医院病案室
4.
137400 兴安盟, 兴安盟人民医院检验科
5.
215000 苏州, 苏州市立医院科教科江苏苏州 215000

基金项目:

国家自然科学基金 81172760

详细信息

通讯作者:
许锬, E-mail: xutan@suda.edu.cn

中图分类号: R181
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- 被引次数: 0
出版历程
- 收稿日期: 2018-12-25
- 修回日期: 2019-04-25
- 刊出日期: 2019-06-10

Association between the combined effect of helicobacter pylori infection and the elevation of C-reactive protein and the prognosis of ischemic stroke

1.
Department of Epidemiology, School of Public Health, Medical College of Soochow University, Suzhou 215123, China
2.
Department of Acute Infectious Disease Control and Prevention, Changzhou Center for Disease Control and Prevention, Changzhou 213000, China
3.
Medical Records Room, Changzhou Traditional Chinese Medicine Hospital, Changzhou 213000, China
4.
Clinical Laboratory, Inner Mongolia Xingan League People's Hospital, Xingan League 137400, China
5.
Department of Science and Research, The Affiliated Suzhou hospital of Nanjing Medical University, Suzhou 215000, China

Funds:

National Natural Science Foundation of China 81172760

More Information

Corresponding author: XU Tan, E-mail: xutan@suda.edu.cn

摘要

摘要: 目的探讨幽门螺杆菌(helicobacter pylori，HP)感染与C-反应蛋白(C-reactive protein，CRP)升高的联合作用与急性缺血性脑卒中3个月不良预后的关系。方法采用前瞻性队列研究，从国内14家医院纳入缺血性脑卒中病例1 110例，检测入院时血清幽门螺杆菌免疫球蛋白G(helicobacter pylori immunoglobulin G，HP-IgG)水平及CRP水平，不良预后定义为发病3个月后的死亡或复合结局(死亡或心血管事件)。根据HP-IgG及CRP是否升高，将所有患者分为四组，：G1为低水平HP-IgG+低水平CRP组，G2为低水平HP-IgG+CRP升高组，G3为HP-IgG升高+低水平CRP组，G4为HP-IgG升高+CRP升高组。采用COX回归方法分析HP-IgG升高和CRP升高的联合作用与不良预后的关系。结果对HP-IgG升高及CRP升高的联合作用分析发现，多因素调整后，与G1(低水平HP-IgG+低水平CRP)患者相比，G4(HP-IgG升高+CRP升高)患者3个月的死亡风险为G1的13.45倍(95%CI：2.83~63.94，P=0.001)，发生复合结局的风险为G1的3.97倍(95%CI：1.79~8.82，P < 0.001)。结论 HP感染与CRP升高的联合作用与脑卒中发病3个月后不良预后有关。
- 幽门螺杆菌 /
- CRP /
- 脑卒中预后 /
- 联合作用
Abstract: Objective To investigate the combined effect of Helicobacter pylori (HP) infection and elevated C-reactive protein (CRP) on the prognosis of acute ischemic stroke patients at 3 months. Methods A prospective cohort study was performed. 1 110 confirmed cases of ischemic stroke were included from 14 hospitals in China. Serum helicobacter pylori immunoglobulin G (HP-IgG) and CRP were tested at admission. Poor prognosis was defined as death and the combined outcome (death or cardiovascular events) at 3 months after onset. All patients were divided into four groups based on whether HP-IgG and CRP were elevated: G1 was low level HP-IgG+ low level CRP group, G2 was low level HP-IgG + elevated CRP group, G3 was elevated HP-IgG + low level CRP group, G4 was elevated HP-IgG + elevated CRP group. The combined effect of elevated HP-IgG and elevated CRP on poor prognosis of ischemic stroke for 3 months was analysed with COX regression analysis. Results Analysis of the combined effects of elevated HP-IgG and elevated CRP showed that, after multifactorial adjustment, G4 (elevated HP-IgG+elevated CRP)patients had a 13.45-fold risk (95%CI: 2.83-63.94, P=0.001) of death at 3 months and 3.97-fold (95%CI: 1.79-8.82, P < 0.001) risk of combined outcome compared with G1(low HP-IgG+ low CRP) patients. Conclusion The combined effect of HP infection and elevated CRP is associated with poor prognosis at 3 months after stroke onset.

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表 1 四组人群基线特征的比较[x±s/M(P₂₅, P₇₅)/n(%)]

Table 1. Baseline characteristics of ischemic stroke cases among participants with or without HP infection and elevated CRP[x±s/M(P₂₅, P₇₅)/n(%)]

基线特征	G1^a	G2^b	G3^c	G4^d	P值
人数	467	88	479	76
年龄(岁)	62.06±11.40	62.85±10.03	62.06±11.40	67.75±12.75^def	< 0.001
男性	317(67.88)	62(70.45)	339(70.77)	44(57.89)	0.148
吸烟	193(41.33)	43(48.83)	214(44.68)	33(43.42)	0.533
饮酒	170(36.40)	39(44.32)	192(40.08)	15(19.74)^def	0.004
收缩压(mmHg)	148.68±22.64	149.00±20.84	148.68±22.64	148.39±22.85	0.985
舒张压(mmHg)	88.74±12.96	88.41±11.67	88.74±12.96	87.18±15.20	0.817
BMI(kg/m²)	24.66±3.09	24.47±3.28	24.66±3.09	23.93±3.31	0.350
甘油三酯(mmol/L)	1.89±1.55	2.00±1.77	1.89±1.55	1.28±0.56	0.073
总胆固醇(mmol/L)	5.03±2.13	6.03±9.69^d	5.03±2.13^e	4.51±1.01^e	0.017
低密度脂蛋白(mmol/L)	3.33±1.70	3.31±1.03	3.33±1.70	3.03±0.87	0.371
高密度脂蛋白(mmol/L)	1.34±1.06	1.31±0.74	1.34±1.06	2.07±7.36^def	0.027
空腹血糖(mmol/L)	7.30±7.33	7.18±3.47	7.30±7.33	7.01±6.97	0.951
白细胞计数(10⁹/L)	6.61(5.40, 8.05)	7.21(5.70, 9.23)	6.70(5.42, 8.22)	8.30(6.50, 10.64)^df	< 0.001
入院NIHSS评分	5.00(3.00, 7.00)	5.50(3.00, 10.00)	5.00(3.00, 7.00)	8.00(4.00, 13.50)^df	< 0.001
高血压史	268(57.39)	54(61.36)	278(58.04)	36(47.37)	0.288
糖尿病史	87(18.63)	21(23.86)	87(18.16)	9(11.84)	0.265
冠心病史	58(12.42)	17(19.32)	71(14.82)	17(22.37)	0.072
卒中家族史	111(23.77)	22(25.00)	96(20.04)	15(19.74)	0.456
HP-IgG(ng/L)	7.27(6.40, 8.72)	7.35(6.42, 8.47)	15.08(11.63, 24.93)^de	14.63(11.30, 20.65)^de	< 0.001
C-反应蛋白(mg/L)	1.69(0.97, 3.17)	16.98(11.24, 25.48)^d	1.83(0.94, 3.22)^e	15.32(10.88, 25.23)^df	< 0.001
死亡	4(0.86)	4(4.55)	17(3.55)^d	13(17.11)^df	< 0.001
复合结局	16(3.43)	6(6.82)	38(7.93)^d	16(21.05)^def	< 0.001
注：^aG1为低水平HP-IgG/低水平CRP组; ^bG2为低水平HP-IgG/CRP升高组; ^cG3为HP-IgG升高/低水平CRP组; ^dG4为HP-IgG升高/CRP升高组; ^def为各组两两比较时的结果：秩和检验和χ²检验校正后的检验水准α’=2α/k(k-1)=2×0.05/(4×3)=0.0083, ^d与GI有差异; ^e与G2有差异; ^f与G3有差异。

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表 2 HP感染、CRP升高与脑卒中预后的关系

Table 2. HRs of HP infection and elevated CRP for the prognosis of stroke

变量	未调整因素		调整因素
变量	HR(95%CI)值	P值	HR(95%CI)值	P值
死亡
HP-IgG升高^a	4.75(1.97~11.45)	< 0.001	3.23(1.26~8.26)	0.015
CRP升高^b	5.36(2.76~10.40)	< 0.001	2.92(1.39~6.11)	0.005
复合结局
HP-IgG升高^a	2.70(1.62~4.50)	< 0.001	2.52(1.48~4.32)	< 0.001
CRP升高^b	2.34(1.43~3.85)	< 0.001	1.56(0.90~2.72)	0.011
注：^a调整因素为: 年龄、性别、吸烟、饮酒、入院NIHSS评分、舒张压、空腹血糖、总胆固醇、白细胞计数、冠心病史、糖尿病史、高血压史和CRP；^b调整因素为: 年龄、性别、吸烟、饮酒、入院NIHSS评分、舒张压、空腹血糖、总胆固醇、白细胞计数、冠心病史、糖尿病史、高血压史、HP-IgG。

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表 3 HP感染和CRP升高的联合作用与脑卒中预后的关系

Table 3. Combined effects of HP infection and elevated CRP on the prognosis of stroke

变量	未调整因素		调整因素
变量	HR(95%CI)值	P值	HR(95%CI)值	P值
死亡
G1^a	1.00		1.00
G2^b	10.36(1.90~56.54)	0.007	7.70(1.36~43.72)	0.021
G3^c	7.65(1.76~33.27)	0.007	5.88(1.32~26.19)	0.020
G4^d	38.83(8.76~172.06)	< 0.001	13.45(2.83~63.94)	0.001
死亡或心血管事件
G1	1.00		1.00
G2	2.19(0.84~5.70)	0.108	1.81(0.67~4.85)	0.239
G3	2.65(1.44~4.88)	0.002	2.67(1.41~5.06)	0.003
G4	6.82(3.33~13.96)	< 0.001	3.97(1.79~8.82)	< 0.001
注：^aG1为低水平HP-IgG+低水平CRP组；^bG2为低水平HP-IgG+CRP升高组；^cG3为HP-IgG升高+低水平CRP组；^dG4为HP-IgG升高+CRP升高组；^e调整因素为: 年龄、性别、吸烟、饮酒、入院NIHSS评分、舒张压、空腹血糖、总胆固醇、白细胞计数、冠心病史、糖尿病史和高血压史。

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表 4 HP感染与CRP升高的交互作用分析

Table 4. Analysis of interaction between HP infection and elevated CRP

结局	COX回归^a		对数线性模型
结局	HR(95%CI)值	P值	估计值(95%CI)	P值
死亡	0.30(0.04~2.01)	0.213	-0.29(-0.62~0.05)	0.095
死亡或心血管事件	0.82(0.25~2.65)	0.742	-0.25(-0.58~0.09)	0.144
注：^a调整因素为: 年龄、性别、吸烟、饮酒、入院NIHSS评分、舒张压、空腹血糖、总胆固醇、白细胞计数、冠心病史、糖尿病史和高血压史。

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基线特征	G1^a	G2^b	G3^c	G4^d	P值
人数	467	88	479	76
年龄(岁)	62.06±11.40	62.85±10.03	62.06±11.40	67.75±12.75^def	< 0.001
男性	317(67.88)	62(70.45)	339(70.77)	44(57.89)	0.148
吸烟	193(41.33)	43(48.83)	214(44.68)	33(43.42)	0.533
饮酒	170(36.40)	39(44.32)	192(40.08)	15(19.74)^def	0.004
收缩压(mmHg)	148.68±22.64	149.00±20.84	148.68±22.64	148.39±22.85	0.985
舒张压(mmHg)	88.74±12.96	88.41±11.67	88.74±12.96	87.18±15.20	0.817
BMI(kg/m²)	24.66±3.09	24.47±3.28	24.66±3.09	23.93±3.31	0.350
甘油三酯(mmol/L)	1.89±1.55	2.00±1.77	1.89±1.55	1.28±0.56	0.073
总胆固醇(mmol/L)	5.03±2.13	6.03±9.69^d	5.03±2.13^e	4.51±1.01^e	0.017
低密度脂蛋白(mmol/L)	3.33±1.70	3.31±1.03	3.33±1.70	3.03±0.87	0.371
高密度脂蛋白(mmol/L)	1.34±1.06	1.31±0.74	1.34±1.06	2.07±7.36^def	0.027
空腹血糖(mmol/L)	7.30±7.33	7.18±3.47	7.30±7.33	7.01±6.97	0.951
白细胞计数(10⁹/L)	6.61(5.40, 8.05)	7.21(5.70, 9.23)	6.70(5.42, 8.22)	8.30(6.50, 10.64)^df	< 0.001
入院NIHSS评分	5.00(3.00, 7.00)	5.50(3.00, 10.00)	5.00(3.00, 7.00)	8.00(4.00, 13.50)^df	< 0.001
高血压史	268(57.39)	54(61.36)	278(58.04)	36(47.37)	0.288
糖尿病史	87(18.63)	21(23.86)	87(18.16)	9(11.84)	0.265
冠心病史	58(12.42)	17(19.32)	71(14.82)	17(22.37)	0.072
卒中家族史	111(23.77)	22(25.00)	96(20.04)	15(19.74)	0.456
HP-IgG(ng/L)	7.27(6.40, 8.72)	7.35(6.42, 8.47)	15.08(11.63, 24.93)^de	14.63(11.30, 20.65)^de	< 0.001
C-反应蛋白(mg/L)	1.69(0.97, 3.17)	16.98(11.24, 25.48)^d	1.83(0.94, 3.22)^e	15.32(10.88, 25.23)^df	< 0.001
死亡	4(0.86)	4(4.55)	17(3.55)^d	13(17.11)^df	< 0.001
复合结局	16(3.43)	6(6.82)	38(7.93)^d	16(21.05)^def	< 0.001
注：^aG1为低水平HP-IgG/低水平CRP组; ^bG2为低水平HP-IgG/CRP升高组; ^cG3为HP-IgG升高/低水平CRP组; ^dG4为HP-IgG升高/CRP升高组; ^def为各组两两比较时的结果：秩和检验和χ²检验校正后的检验水准α’=2α/k(k-1)=2×0.05/(4×3)=0.0083, ^d与GI有差异; ^e与G2有差异; ^f与G3有差异。

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幽门螺杆菌感染与C-反应蛋白升高的联合作用与缺血性脑卒中预后的关系

doi: 10.16462/j.cnki.zhjbkz.2019.06.008

通讯作者:
许锬, E-mail: xutan@suda.edu.cn

计量

Association between the combined effect of helicobacter pylori infection and the elevation of C-reactive protein and the prognosis of ischemic stroke

Corresponding author: XU Tan, E-mail: xutan@suda.edu.cn

计量

目录

留言板

幽门螺杆菌感染与C-反应蛋白升高的联合作用与缺血性脑卒中预后的关系

doi: 10.16462/j.cnki.zhjbkz.2019.06.008

通讯作者: 许锬, E-mail: xutan@suda.edu.cn

计量

出版历程

Association between the combined effect of helicobacter pylori infection and the elevation of C-reactive protein and the prognosis of ischemic stroke

Corresponding author: XU Tan, E-mail: xutan@suda.edu.cn

计量

出版历程

目录

通讯作者:
许锬, E-mail: xutan@suda.edu.cn