Efficacy Of Anti-helicobacter Pylori Therapy On Early Kidney Disease Associated With Type 2 Diabetes Mellitus

Objective To explore the clinical efficacy of anti-Helicobacter pylori(H.pylori) therapy on early diabetic kidney disease(DKD) associated with type 2 diabetes mellitus.Methods One hundred and thirty-eight type 2 diabetes mellitus patients with kidney disease staged as Mogensen Ⅲ, were enrolled in this study. They accepted inpatient and outpatient treatment in our hospital from January 2013 to December 2013. Carbon 14 urea breath test(14C-UBT) was used for the detection of H.pylori infection. H.pylori was found to be positive in 80 cases, who were further randomly assigned into anti-H.pylori group(n=40) and without anti-H.pylori group(n=40). All of them accepted routine treatment including diabetes education, reasonable exercise, glucose lowering and kidney protecting therapy for 3 months, and keep the HHbloodHH HHglucoseHH and blood pressure within a certain range during follow-up. Patients in anti-H.pylori group received additional anti-H.pylori therapy for 7 days with the standard triple regimen(Lansoprazole 15 mg po. bid, Amoxicillin 1.0 g po. bid, and Clarithromycin 0.5 g po. bid). In both groups, clinical index including fasting blood glucose(FBG), 2 h plasma glucose(2 h PG), hemoglobin A1c(Hb A1c), systolic blood pressure(SBP), diastolic blood pressure(DBP), cholesterol(TC), triglyceride(TG), urinary albumin /creatine ratio(UACR), C-reactive protein(CRP), tumor necrosis factor(TNF), plasma endothelin(ET-1) and homocysteine(HCY) were recorded before and after 3 months of treatment. In addition, patients in anti-H.pylori group were reevaluated for the H.pylori infection by 14C-UBT after 3 months of treatment. Results were expressed as mean±SD.Quantitative data in two groups were compared by independent-samples t test. Quantitative data before and after treatment within one group were compared by paired-samples t test. Categorical data were compared with χ2 test. P value<0.05 was considered to be statistically significant.Results 1. H.pylori infection was positive in 80/138(57.97%)patients with Mogensen stage III DKD by screening with 14C-UBT; 2. Seventy-five patients in 80 patients with H.pylori infection fulfilled the whole study, including 39 cases in anti-H.pylori group and 36 cases in without anti-H.pylori group. No significant difference was observed in gender, HHageHH, diabetes course, body mass index(BMI), blood glucose(FBG, 2h PG, Hb A1c), blood pressure(SBP, DBP), lipid(TG, TC), UACR, CRP, TNF-α, ET-1 and HCY between two groups before treatment(P>0.05). 3. Eradicating rate of H.pylori in anti-H.pylori group(56.41%) was higher than that in without anti-H.pylori group(5.6%) after 3 months of treatment(P<0.01). 4. The levels of blood glucose(FBG, 2h PG, Hb A1c), blood pressure(SBP, DBP), and lipid(TG, TC) after 3 months of treatment did not changed significantly from baseline in both groups(P >0.05). 5. In contrast, the serum levels of UACR, CRP, ET-1, TNF-α and HCY in both groups decreased significantly after 3 months of treatment(P<0.01); Besides, the serum levels of UACR, CRP, ET-1, TNF-α and HCY in the anti-H.pylori group was significantly lower than that in without anti-H.pylori group(P<0.05).Conclusions Anti-H.pylori therapy may play a role in postponing the progression of early DKD in patients with type 2 diabetes, through controlling the serum levels of UACR, CRP, ET-1, TNF-α, and HCY.