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Abstract：
Objectives Helicobacter pylori (H. pylori) is known to affect a large proportion of the world population. It plays a role in the pathogenesis of peptic ulcer (PU) and increases the likelihood of bleeding. In critically ill patients in intensive care units (ICUs), the risk of bleeding may be much higher due to many concomitant factors. The study aimed to determine the activation of H. pylori in mechanically ventilated (MV) intensive care patients and compare this with the general population. Methods This study was performed retrospectively by screening patients who underwent esophagogastroduodenoscopy and histopathological sampling in our hospital between January and June 2023. The study included 79 patients aged between 18 and 85 years. The patients were categorized into two groups: 35 patients in the ICU with mechanical ventilation (MV) support (EMV) and 44 patients who presented to the gastroenterology department due to dyspeptic symptoms and underwent endoscopy (ED). Age; sex characteristics; laboratory parameters such as hemoglobin (Hb), hematocrit (Htc), mean cellular volume (MCV), white blood cell (WBC), neutrophil, platelet, glucose, urea, creatinine, aspartate transaminase (AST), alanine transaminase (ALT), C-reactive protein (CRP), albumin, ferritin, thyroid-stimulating hormone (TSH), anti-hepatitis C virus (HCV), hepatitis B surface antigen (HBsAg), anti-HIV; and biopsy results (H. pylori positivity, intestinal metaplasia, and atrophy) were recorded. Results A total of 79 patients who underwent gastric biopsy were assessed. There were 35 patients in the EMV group and 44 patients in the ED group. There was no difference in gender and age distribution between the groups. Hb and Htc were significantly lower in EMV compared to ED (p=0.001). Hb was 9.4±1.7 g/dL in EMV and 10.8±2.1 g/dL in ED. Htc was 29.6±5.1 in EMV and 33.5±5.7 in ED. MCV, WBC, glucose, urea, AST, ALT, CRP, and ferritin values were statistically significantly higher in EMV (p<0.05). Albumin and creatinine levels were statistically significantly lower in EMV (p<0.05). There was no significant difference between the groups in terms of neutrophils, platelets, and TSH. In the EMV group, H. pylori activity was negative in 31 (88.6%) patients and positive in four (11.4%) patients. In the ED group, H. pylori activity was negative in 30 (68.2%) patients and positive in 14 (31.8%) patients. There was a statistically significant difference between the groups in terms of H. pylori positivity (p=0.032). Conclusions The prevalence of H. pylori in MV patients in the ICU is low compared to the average population. The incidence of atrophic gastritis and intestinal metaplasia is the same. The present study supports that ICU cases do not have a higher risk of gastric premalignant lesions compared to the average population.
摘要：
目的幽门螺杆菌(H.pylori）已知会影响世界人口的很大一部分。它在消化性溃疡（PU）的发病机理中起作用，并增加出血的可能性。在重症监护病房（ICU）的危重患者中，由于许多伴随因素，出血的风险可能更高。该研究旨在确定机械通气（MV）重症监护患者中幽门螺杆菌的激活，并将其与普通人群进行比较。方法对2023年1月至6月在我院接受食管胃十二指肠镜检查和组织病理学取样的患者进行回顾性筛查。该研究包括79名年龄在18至85岁之间的患者。将患者分为两组：35例ICU中接受机械通气（MV）支持（EMV）的患者和44例因消化不良症状出现在消化内科并接受内窥镜检查（ED）的患者。年龄；性别特征；实验室参数，如血红蛋白（Hb），血细胞比容（Htc），平均细胞体积（MCV），白细胞（WBC），中性粒细胞,血小板,葡萄糖，尿素,肌酐,天冬氨酸转氨酶（AST），丙氨酸转氨酶(ALT),C反应蛋白(CRP),白蛋白,铁蛋白,促甲状腺激素(TSH),抗丙型肝炎病毒（HCV），乙型肝炎表面抗原（HBsAg），抗HIV；和活检结果(H.幽门螺杆菌阳性,肠上皮化生,和萎缩）被记录。结果79例患者均行胃活检。EMV组35例，ED组44例。组间性别和年龄分布无差异。与ED相比，EMV中的Hb和Htc显着降低（p=0.001）。EMV中Hb为9.4±1.7g/dL，ED中Hb为10.8±2.1g/dL。EMV的Htc为29.6±5.1，ED为33.5±5.7。MCV,WBC,葡萄糖，尿素,AST,ALT,CRP,和铁蛋白值在EMV中具有统计学意义（p<0.05）。白蛋白和肌酐水平在EMV中具有统计学意义(p<0.05)。在中性粒细胞方面，两组之间没有显着差异，血小板,和TSH。在EMV组中,31例(88.6%)患者幽门螺杆菌活性为阴性,4例(11.4%)患者为阳性。在ED组中,30例（68.2％）患者的H.pylori活性为阴性，14例（31.8％）患者为阳性。就幽门螺杆菌阳性而言，两组之间存在统计学上的显着差异（p=0.032）。结论与一般人群相比，ICUMV患者中幽门螺杆菌的患病率较低。萎缩性胃炎和肠上皮化生的发病率相同。本研究支持ICU病例与普通人群相比，胃癌前病变的风险并不高。
