住院老年高血压患者幽门螺杆菌感染与衰弱的相关性研究

背景　衰弱是一种常见的老年综合征，可严重影响老年人身心健康。幽门螺杆菌（H.pylori）感染在全世界高发，还与多种胃外疾病的发生、发展相关，但目前H.pylori感染与衰弱的相关性尚不明确。目的　探讨住院老年高血压患者H.pylori感染与衰弱的相关性。方法　连续选取2018年10月-2019年6月在石河子大学医学院第一附属医院老年医学科及心内科住院治疗、年龄≥65岁的高血压患者206例。收集患者一般资料和实验室检查结果，并根据胃黏膜活检结果评估H.pylori感染情况。采用FRAIL量表对患者进行衰弱评估。采用多因素Logistic回归分析探讨住院老年高血压患者H.pylori感染对衰弱的影响。结果　根据FRAIL量表，47例（22.8%）评估为衰弱，159例（77.2%）评估为非衰弱。多因素Logistic回归分析结果显示，年龄〔OR=1.309，95%CI（1.136，1.508）〕，文化程度为小学〔OR=0.107，95%CI（0.026，0.442）〕、初中〔OR=0.127，95%CI（0.028，0.574）〕、高中〔OR=0.013，95%CI（0.000，0.424）〕，白细胞计数〔OR=4.260，95%CI（1.202，15.097）〕，淋巴细胞百分比〔OR=0.793，95%CI（0.676，0.930）〕，中性粒细胞计数〔OR=0.139，95%CI（0.021，0.907）〕，果糖胺〔OR=13.099，95%CI（2.136，80.337）〕，多重用药〔OR=5.679，95%CI（1.486，21.709）〕，跌倒/坠床危险评分〔OR=1.788，95%CI（1.236，2.586）〕，H.pylori感染〔OR=2.912，95%CI（1.036，8.181）〕为住院老年高血压患者衰弱的影响因素（P<0.05）。将衰弱患者根据H.pylori感染情况进一步分组，其中H.pylori阳性患者26例（55.3%），H.pylori阴性患者21例（44.7%）。H.pylori阳性患者与H.pylori阴性患者单核细胞计数、白细胞计数、中性粒细胞计数、总蛋白、白蛋白水平比较，差异均无统计学意义（P>0.05）。结论　住院老年高血压患者H.pylori感染可能是导致其衰弱的危险因素，临床医师在加强衰弱评估的同时，也应重视H.pylori感染带来的相关影响。

Correlation between Helicobacter Pylori Infection and Frailty in Hospitalized Elderly Patients with Hypertension

Background　Frailty is a common geriatric syndrome，which seriously affects the physical and mental health of the aged.Helicobacter pylori （H.pylori） infection has a high global incidence，which is associated with the occurrence and development of multiple extra-gastric diseases.However，the correlation between H.pylori infection and frailty is unclear.Objective　To investigate the correlation between H.pylori infection and frailty in hospitalized elderly patients with hypertension.Methods　206 consecutive hospitalized patients with hypertension aged ≥ 65 from Departments of Geriatrics and Cardiovascular Medicine，First Affiliated Hospital，School of Medicine，Shihezi University from October 2018 to June 2019 were included.H.pylori infection prevalence in gastric mucosal biopsy specimens was detected by pathological examination，and other clinical data were collected.The prevalence of frailty was assessed by the FRAIL scale.The effect of H.pylori infection on frailty was analyzed by multivariate Logistic regression analysis.Results　47 cases （22.8%） were assessed to be frail and other 159 （77.2%） were non-frail.The results of multivariate Logistic regression analysis showed that age〔OR=1.309，95%CI（1.136，1.508）〕，primary school education〔OR=0.107，95%CI（0.026，0.442）〕，junior high school education〔OR=0.127，95%CI（0.028，0.574）〕，senior high school education〔OR=0.013，95%CI（0.000，0.424）〕，leukocyte counts〔OR=4.260，95%CI（1.202，15.097）〕，lymphocyte percentage〔OR=0.793，95%CI（0.676，0.930）〕，neutrophil counts〔OR=0.139，95%CI（0.021，0.907）〕，fructosamine〔OR=13.099，95%CI（2.136，80.337）〕，polypharmacy〔OR=5.679，95%CI（1.486，21.709）〕，score of risk of fall/falling out of bed 〔OR=1.788，95%CI（1.236，2.586）〕 and H.pylori infection〔OR=2.912，95%CI（1.036，8.181）〕 were associated with higher risk of frailty in hospitalized patients with hypertension （P<0.05）.Analysis based on H.pylori infection prevalence in frail patients showed that，there was no significant difference in total protein，albumin，monocyte counts，leukocyte counts and neutrophil counts between H.pylori infected patients〔55.3%（26/47）〕 and H.pylori uninfected patients〔44.7%（21/47）〕（P>0.05）.Conclusion　H.pylori infection might be a risk factor leading to frailty in hospitalized elderly patients with hypertension.In view of this，clinicians should not only strengthen the assessment of frailty，but also attach great importance to the influence of H.pylori infection.