4. 经过“筛查和治疗”防治策略后玻利维亚儿童和成人幽门螺杆菌的复发情况
Helicobacter. 2014 Oct;19(5):343-8. doi: 10.1111/hel.12137. Epub 2014 May 16.
Recurrence of Helicobacter pylori infection in Bolivian children and adults after a population-based "screen and treat" strategy.
Sivapalasingam S1, Rajasingham A, Macy JT, Friedman CR, Hoekstra RM, Ayers T, Gold B, Quick RE.
背景：
基于人群的“筛查和治疗”根除项目是通过降低高感染率、低收益的地区幽门螺杆菌感染从而预防胃癌的战略之一。
方法：
使用尿素呼气试验对两个村庄的居民进行了HP感染的检测，并对感染者予以监测下的药物治疗，在治疗后及1年后复查呼气试验。
结果:
我们检测了玻利维亚农村两个村庄的1153人中的1,065人(92%) 。幽门螺杆菌感染基线是80% (95% 可信区间[CI]: 78-84)。监测下的药物治疗年龄特异的根除率是相似的(≥92%)。治愈的患者中12% (95% CI: 8-15)感染复发。两个村庄5岁以下、5-9岁、10-14岁、大于等于15岁患者幽门螺杆菌年感染率分别为20% (95% CI: 10-29)、20% (95% CI: 10-29), 8% (95% CI: 1-15)和8% (95% CI: 4-12)。小于五岁的患者(odds ratios [OR] 2.7, 95% CI: 1.2-5.8)及5-9岁的患者(OR 2.7, 95% CI: 1.4-5.1)与大于等于15岁的患者相比更易复发。
结论：
结果显示小于十岁的儿童感染复发率较高，提示这一幽门螺杆菌的根除策略并不适用于高感染率、低收益的地区。
译者点评：本文结果提示在高感染率、低收入地区的幽门螺杆菌再感染率较高。
Abstract
BACKGROUND:
Strategies to prevent gastric cancer by decreasing Helicobacter pylori infections in high-prevalence, low-income countries could include a population-based "screen and treat" eradication program.
METHODS:
We tested residents of two rural villages for H. pylori infection using urea breath test (UBT), treated infected persons using directly observed therapy (DOT), retested for cure, and retested after 1 year later for H. pylori infection.
FINDINGS:
We tested 1,065 (92%) of 1153 residents from two villages in rural Bolivia. Baseline H. pyloriprevalence was 80% (95% confidence interval [CI]: 78-84). Age-specific cure rates were similar (≥92%) after DOT. Among those cured, 12% (95% CI: 8-15) had recurrent infection. Age-specific annual H. pylorirecurrence rates for combined villages were 20% (95% CI: 10-29) in persons <5 years, 20% (95% CI: 10-29) in 5-9 years, 8% (95% CI: 1-15) in 10-14 years, and 8% (95% CI: 4-12) in persons ≥15 years. Compared with the referent population, those ≥15 years, recurrent infections were significantly more likely in children <5 years (odds ratios [OR] 2.7, 95% CI: 1.2-5.8) and 5-9 years (OR 2.7, 95% CI: 1.4-5.1).
INTERPRETATION:
Children <10 years had high H. pylori recurrence rates following a population-based screen and treat program; this H. pylori eradication strategy may not be feasible in high-prevalence, low-income settings.