Association Of Helicobacter Pylori Infection With Type 2 Diabetes Mellitus And Diabetic Kidney Disease

Purpose:Diabetic and diabetic kidney disease patients often associated with dyspepsia symptoms,There are limited studies in this area.The relationship between H. pylori infection and diabetic kidney disease was unknown.The aim of this conventional case-control study was to investigate the prevalence and relationship between Helicobacter pylori infection in type 2 diabetes mellitus(DM) and diabetic kidney disease(DKD).Methods: A total of 241 type 2 diabetic patients and 69 non-diabetic subjects with dyspeptic symptoms were enrolled in the study. Gastroduodenal lesions were observed by gastrointestinal endoscopy and the presence of Helicobacter pylori infection was identified by rapid urease test and serum Ig G antibodies to Helicobacter pylori. According to the urinary albumin excretion rate(UAE), patients were classified into diabetes mellitus group(DM group, with UAE< 30 mg/24 h); diabetic nephropathy group 1(DN group 1, with UAE 30 mg/24 h to <300 mg/24 h); and diabetic nephropathy group 2(DN group 2,with UAE≥300 mg/24 h),The glomerular filtration rate of the patients in the above 3 groups were all greater than 60% ml/min1.73m2. The 69 non-diabetic subjects were used as control group. The serum levels of inflammatory factors such as tumor necrosis factor-α(TNF-α) and interleukin(IL)-8 were determined using ELISA in diabetic nephropathy group 1 and diabetic nephropathy group 2.Results: The prevalence of H pylori infection in DN group 1 and DN group 2 was 45/72(62.5%) and 34/53(64.15%), respectively,which was significantly higher than in control[28/65(43.1%)] and DM groups[42.9%(27/63)]. No significant differences of H. pylori prevalence were detected between DN groups as well as DM and control groups.Endoscopy results show normal gastroscopy in diabetes patients with history of digestive tract symptoms(36/63) higher than control groups(25/65)(38.5% vs 57.1%,P=0.034). No statistically significant differences were detected in the endoscopic findings between these four groups.Interestingly, in both DN groups, higher levels of IL-8,TNF-α and urinary albumin excretion rate were found in H. pylori positive subjects.Conclusion:Diabetic kidney disease patients are more susceptible to Helicobacter pylori infection. There was no significant difference in the infection rate of Helicobacter pylori between type 2 diabetic kidney disease with microalbuminuria and with macroalbuminuria.there were no significant difference in the type of gastric mucosal lesion among Type 2 diabetes mellitus 、diabetic kidney disease patients and non diabetic patients. Helicobacter pylori may associate with increased proteinuria, elevated levels of these inflammatory cytokines and the development of diabetic kidney disease.