Correlative Study Between Helicobacter Pylori Infection And Glucose And Lipid Metabolism

BackgroundWith the development of the economy, changes of people’s living style and the increasing population aging phenomena, cardiovascular disease and diabetes have become one of the major disease to human health. It’s critical to control the hazards as lipid level and blood glucose to prevent such kinds of diseases. A research in 2002 showed that the incidence of dyslipidemia was 18.6% among the people above 18 years old. A research done in Guangdong Province from 2010 indicated that the incidences of dyslipidemia among people above 18 years old, male, and female were 60.7%,68.9% and 54.0% respectively, the results of which were close to other provinces as well. China has the largest populations with diabetes and the age standardization rate among people above 20 years old was 9.7% while the number of adult diabetes patients reached 9.24 million with a prediabetic state of 15.5%. The number of diabetes patients was still on the rise. Therefore, a deeper study on the factors to glucolipid metabolism will make profound significance on the hyperlipidemia and diabetes prevention. In addition to the common factors as inheritance, diet habits, environment, other factors to affect the lipid and glucose metabolic should also be discussed and studied in-depth.Helicobacter pyloris (Hp) is a Gram-negative, microaerophilic bacterium found in the stomach. Infection of Helicobacter pylori is most prevalent around the world with more than 50% of the world’s population harbor H. pylori. In 2002-2004, a large epidemiological investigation on Hp done in 19 provinces and 39 central cities by the Hp group of gastroenterology branch in Chinese Medical Association (CMA) showed that Hp infection rate of Chinese people was 40% to 90%, with an average infection rate of 59% and the infection rate in Guangdong province was 42%. More and more evidence proved that Hp infection may lead to other parenteral diseases besides the gastric diseases Plenty of studies displayed that Hp infection may cause various metabolic disorders, especially lipid and gluconic metabolism. However, such kinds of researches were yet controversial in different countries and might bring up antipodal conclusions.A research from Finland in 1996 reported that the triglyceride(TG) level of Hp infectors was higher while the high density lipoprotein cholesterol (HDL-C) was lower than the Hp negative people among the people with coronary heart disease(CHD) or non CHD patients. Seoul National University initiated an investigation on 462 old people whose average ages were over 66.2 in 2011 and found that the low density lipoprotein cholesterin (LDL-C) of the Hp infectors was higher, with OR value of 3.1, than those got uninfected after adjusting confounding factors. Therefore, it was deduced that Hp would cause the atherosclerosis by changing the lipid form. An analysis on the Hp infection and ischemic stroke sequelae conducted in 2002 concluded that the serum total cholesterol (TC) and low density lipoprotein cholesterin (LDL-C) were higher in the Hp positive people than the Hp negative ones and both indexes dropped down dramatically after 6 months of Hp treatment. Nevertheless, there were also many opposite opinions showed that Hp infection was not related to lipid increase and the elimination of Hp did no help to the lipid. For example, certain researches done in Japan from 2002 to 2004 found that the number of people with hyperlipemia and obesity became higher after Hp treatment. It was well known that the diabetes people were easier to get infection, with no exception of Hp infection. Some people thought that the damaged cell and humoral immune response caused by diabetes added the possibility of Hp infection. The weak gastric bowel peristalsis and reduced gastric acid secretion of diabetes people increased the risk of Hp engraftment. Simon reported in 1989 that the Hp infection rate in the diabetes patients was higher than the matched group and a report in 1996 from Finland showed that however that type 1 or type 2 diabetes patients were, the Hp infection rate in each age group was higher than the matched group. Yet Ciortescu and Oluyemi did a research in 2009 and 2012 to find that there were no significant difference comparing the T2DM group and non T2DM group. Quite a few people held the opinions that the Hp infection was involved in the diabetes development, of which a research done in 2010 on the Japanese people indicated that the Hp infection raised the insulin resistance rate to the onset of diabetes. In 2012, Jeon et al conducted a prospective cohort study on 782 Latino Americans over 60 years old and found that Hp increased the morbidity of diabetes. On the other side, plenty of studies also showed that Hp infection was not related to the morbidity of diabetes. Gillum et al claimed that Hp infection had no relations with insulin resistance in 2004. Naja et al initiated a study in 2012 to 308 adults on the relationship between the insulin resistance and metabolic syndrome and concluded that Hp infection was uncorrelated to T2DM and insulin resistance.ObjectiveIn view of the controversies between the correlation of Hp infection and glucolipid metabolism, this thesis aimed to conducting an investigation on 13C-urea breath test, blood sugar, lipid and insulin of the physical examination people in Guangzhou to study the Hp infection conditions in Guangzhou, comparison of Hp infection between well-beings and diabetes patients, comparison of Hp infection in different genders, age group and correlations between Hp infection and the incidence of dyslipidemia. The thesis also further studies the impaired glucose regulation (IGR) people and normal glucose regulation(NGR) people to see whether the Hp infection was related to insulin resistance and pancreatic (3 cell impaired. The thesis also aimed at discussing the possibility of Hp to cause diabetes, and providing evidence and fresh ideas for other studies, like, whether the Hp treatment was helpful to reduce the incidence of dyslipidemia, diabetes, and other complication to prevent and treat hyperlipidemia diseases and diabetes.Material and Method1. Objective938 healthy people aging from 22 to 89 who took health examination in Guangzhou cadre sanatorium from January 2013 to August 2014 were enrolled in the lipid study, with average age of 50.5±10.49. And 399 (aging from 26 to 89)of the 938 people were enrolled in the blood sugar and insulin resistance study, with an average age of 54.1±7.20. Inclusion criteria:1) Participants were above 20 years old. 2) Participants had no acute or chronic inflammation.3) Participants did not take any antibiotic, H2 receptor antagonist, proton pump inhibitor or bismuth preparations, etc within a month.4) Participants never employed lipid reduction treatment. Exclusion criteria:1) Have been diagnosed with diabetes, and coronary disease.2) Suffering from severe liver disease, kidney disease, or nausea tumor.3) Had Hp eradication therapy and stomach surgery history.4) Had genetically severe blood lipid metabolic abnormalities.2. MethodsCollect general information of the names, genders, and ages, and measured blood pleasure, height and weight of the 938 participants. All the participants took the Hp test with 13C-urea breath test method. The participants were forbidden to eat anything after ten o’clock at night and were extracted 5-10ml fasting venous blood the next morning to test the fasting blood-glucose, lipid and hormone index, etc. The 399 participants joined in blood sugar and insulin resistance study were tested of sugar tolerance.3. Statistical ProcessSPSS 19.0 statistics software were used to analysis of data. The data nonconforming to normal distribution was transferred by natural logarithm and displayed with means ±standard deviation. Pairwise comparison t test were used in the measurement data between groups; employ logistic analysis of regression to analyze multiple factors; apply chi-square test to compare the enumerations data; P< 0.05 means there was statistical significance.Results1. General information comparison1.1 The Hp infection rates comparisons between healthy participants and diabetes patients.The Hp infection rates of the healthy participants and diabetes patients were respectively 38.27% and 39.64%. There was no statistically significance between two groups (P>0.05)1.2 The Hp infection rates comparisons between the healthy males and femalesThe Hp infection rates of healthy male and female were respectively 39.34%and 36.57%. There was no statistically significance between two groups.1.3 The Hp infection rates comparisons in different age groups.The healthy participants were divided into 6 groups aging from 20 years old and the age gap between each group was 10 years. The comparison results showed that there was no statistically significance between two groups.1.4 The Hp positive rates comparisons of groups with different body mass indexAccording to the 2003 China Adults Overweight and Obesity Prevention and Control Guideline,the Hp comparisons were done according to different BMI of< 18.5(low weight)、18.5～23.9(normal weight)、24.0～27.9(overweight)、≥28(obesity). The results presented that the Hp infection rate increased as the body mass index increased. There was statistically significance between the normal weight group and obesity group about the Hp infection rates.2. Study on lipid and Hp infection of the healthy participants2.1 The lipid comparisons between Hp positive group and Hp negative groupThe number of the Hp positive participants and Hp negative participants were respectively 359 and 579 among the total 938 participants. There was no statistically significance of ages and genders between the Hp positive and Hp negative groups. The levels of TC, TG, LDL-C, APO-B, FPG, UA, BMI, WBC, HCT, Gr were higher than the negative group while HDL-C level was lower than the negative group. There was statistically significance on these differences (P<0.05)2.2 The correlations between Hp infection and the incidence of dyslipidemiaAccording to 2007 China Adults Lipid Prevention Guideline, the lipid was diagnosed as abnormal in case of any of the four types:1) Simple high blood triglycerides with TG≥2.26 mmol/L and TC<6.22 mmol/L; 2) Simple hypercholesterolemia with TG ≥6.22 mmol/L and TC<2.26 mmol/L; 3) Combined hyperlipidemia with TG≥2.26 mmol/L and TC≥6.22 mmol/L; 4) Simple low high-density lipoprotein cholesterol with HDL-C<1.04 mmol/L without Simple high blood triglycerides and Simple hypercholesterolemia with. One would be diagnosed as dyslipidemia in case of any of the above situations. The results showed that the incidences of dyslipidemia in Hp positive group and negative group were 52.65% and 20.55%. There was statistically significance between two groups (P<0.05)2.3 The relations on different ages, Hp infection to dyslipidemiaThe healthy participants were divided into 6 groups aging from 20 years old and the difference between each group was 10 years. The results showed that as the ages increased, the incidences of dyslipidemia were higher from 20 to 70years old. The incidences of dyslipidemia in Hp positive group was much significant than Hp negative group as the ages increased.2.4 The abnormal incidences comparisons of the four serum lipid parametersAccording to 2007 China Adults Serum Lipid Prevention Guideline, TC≥6.22mmol/L and TG>2.26 mmol/L, and LDL-C≥4.14 mmol/L means increasing, while HDL-C<1.04 mmol/L means reducing. The abnormal incidences of the four serum lipid parameters in the Hp positive group and Hp negative group were 26.74% vs 10.19%,28.69% vs28.69%,6.13%vs2.25%,12.53%vs6.56%. There was statistically significance of the abnormal incidences of the four serum lipid parameters between two groups (P< 0.05)2.5 The Logistic analysis of regression between the Hp infection and dyslipidemiaApply binary variable method of Logistic analysis of regression, with the ages, genders, BMI, DOB, Hp positive or negative, systolic pressure, diastolic pressure, FBG regarded as independent variable, while the dyslipidemia as dependent variable. The results displayed that Hp infection, ages, diastolic pressure, FBG were dangerous factors to dyslipidemia.3 Hp infection and glycometabolism and insulin resistance study3.1 Comparisons of glycometabolism index and other index between the Hp positive group and Hp negative group.The comparisons results of glycometabolism, HOMA-IR, HBCI between the Hp negative group and Hp positive group indicated that there was statistically significance on the differences of FPG and FUSTS and HOMA-IR between the two groups.3.2 Comparisons on the incidence rates of the insulin resistance patients between the Hp positive group and Hp negative groupAccording to the insulin resistance conditions of Chinese people published by Professor Weiping Jia in 2002, people with HOMA-IR of 2.8 were classified as IR people. The IR rate in the Hp positive group was 34.76% and the negative group of 23.4%. There was statistically significance between the two groups (P<0.05).3.3 Comparisons on the incidence rates of impaired glucose regulation (IGR) between the Hp positive group and Hp negative groupAccording to the diabetes diagnostic code of WHO in 1999:fasting blood-glucose≥6.1 and<7.0mmol/L was considered impaired fasting glucose(IFG); postprandial 2 hours plasma glueose≥7.8 and<11.1mmol/L was considered impaired glucose tolerance(IGT), IGT and/or IFG was considered impaired glucose regulation(IGR); fasting blood-glucose<6.1mmol/L and postprandial 2 hours plasma glucose<7.8mmol/L was considered normal glucose regulation(NGR). The results showed that the incidence rate of impaired glucose regulation (IGR) between the Hp positive group and Hp negative group were 43.29% and 32.34% and there was statistically significance between the two groups (P<0.05).3.4.1 After the oral glucose tolerance test (OGTT),252 of the 399 participants were diagnosed NGR, of which 93 Hp positive and 159 Hp negative. The results of glucose metabolism index on the two groups indicated there was no statistically significance on the values of FPG,2hPG, FINS, HOMA-IR (P>0.05).3.4.2 After the oral glucose tolerance test (OGTT),45 of the 399 participants were diagnosed IFG, of which 22 Hp positive and 23 Hp negative. The results of glucose metabolism index on the two groups indicated there was statistically significance on the values of FINS, HOMA-IR and HBCI (P<0.05).3.4.3 After the oral glucose tolerance test (OGTT),74 of the 399 participants were diagnosed IGT, of which 35 Hp positive and 41 Hp negative. The results of glucose metabolism index on the two groups indicated there was no statistically significance on the values of FPG、2hPG、FINS、HOMA-IR (P>0.05).3.4.4 After the oral glucose tolerance test (OGTT),26 of the 399 participants were diagnosed IFG and IGT, of which 14 Hp positive and 12 Hp negative. The results of glucose metabolism index on the two groups indicated there was statistically significance on the values of FINS and HOMA-IR (P>0.05).4. Study on Hp infection and metabolic syndromeThe 399 healthy participants were included into the metabolic syndrome study. According to definitions of metabolic syndrome by the CMA diabetes branch in 2004, a person was considered MS in case of any of the following situations:1) Overweight and/or obesity:BMI>25.0(Kg/m2); 2) Diabetes or IFG:FBG>6.1mmol/L(140mg/dl) and/or postprandial 2 hours plasma glucose>7.8mmol/L(140mg/dl) and/or receiving diabetes treatment; 3) Hypertension:SBP/DBP>140/90mmHg, and/or receiving hypertension treatment; 4) Dyslipidemia:TG>1.7mmol/L(150mg/dl) and/or male HDL-C<0.9mmol/L(35mg/dl) or female HDL-C<1.0mmol/L(39mg/dl). Based on the above criteria, the study found the incidances of metabolic disorder between the Hp positive group and Hp negative group were:Overweight 46.34%vs37.87%; hyperglycemia 43.29%vs32.34%, Hypertension34.15%vs20.85%, Dyslipidemia: 51.22%vs22.13%, metabolic syndrome 27.44%vs 12.77%. The results revealed the incidences of hyperglycemia Hypertension Dyslipidemia and metabolic syndrome were higher in Hp positvie group than in Hp negative group (P<0.05)Conclusions1. The study showed that the Hp infection rates between the diabetes patients and people without diabetes were 39.64% and 38.27%. There was no statistically significance between the two groups. Therefore, the Hp infection rate of the diabetes patients did not increase.2. The study concluded that the Hp infection rate increased with the BMI value. The Hp infection rates between the group with normal body weight and group with overweight were 35.27% and 51.35%. There was statistically significance between the two groups.3. The logistic analysis of regression indicted that hazards as Hp infection, age, diastolic blood pressure, FBG were risk factors to cause hyperlipidemia. The OR and 95%CI of the Hp infection rates were 4.201 and 3.108-5.679, which was much higher than other factors.4. The incidence of the hyperlipemia was on the increase with increasing ages from 20 to 70. The incidence of the hyperlipemia in Hp positive group above 30 years old was higher than Hp negative group and the trends of the incidence of the hyperlipemia in Hp positive group was more obvious than the Hp negative group.5. This study shows that the prevalence of insulin resistance (IR) and impaired glucose regulation (IGR) in healthy populations are correlated with Hp infection.6. This study shows that, in IFG and IFG+IGT crowd Hp positive group of FINS and HOMA-IR are higher than negative group.7. The three metabolic indexs of hyperglycemia, hypertension and dyslipidemia and metabolic syndrome in Hp positive group were higher than in the Hp negative group.