Prevalence of helicobacter pylori infection among Egyptian children with nephrotic syndrome: a single center study.

Background: Increasing attention has been paid for the possible role of helicobacter pylori (H.pylori) infection in nephrotic syndrome (NS) pathogenesis. Objectives: We investigated the frequency, possible role and risk factors of H. pylori among NS children. Methods: We conducted a cross-sectional comparative study in a university-affiliated children’s hospital, Egypt from January 2017 to January 2019. We enrolled 100 children with primary NS (NS group) and 100 healthy controls. All patients were assessed for gastritis symptoms, response to steroid therapy, dose and duration of steroid therapy. H. pylori infection was investigated using H.pylori stool antigen (HpSA) test. Renal histopathology results were retrieved. Chi-square, Fisher exact and Mann-Whitney tests were used for statistical analysis. Results: With regards to HpSA test results, neither statistically significant difference was found between NS and control groups (p =0.193) nor between steroid sensitive and steroid resistant NS subgroups (p =0.286). Mesangioproliferative glomerulonephritis and minimal change disease (MCD) were the most common renal histopathology findings in NS group. Minimal change disease (MCD) was the most frequent histopathology finding in H.pylori positive patients (9 patients, 45%) with statistically significant difference in comparison to H.pylori negative patients (p =0.013). High dose steroid was associated with an increased risk of H.pylori infection among NS children (Odds ratio [OR] = 3.8; 95% confidence interval [CI] = 1.3-11.3). Conclusions: The current study negated the role of H.pylori infection in primary NS pathogenesis. High dose steroid is associated with an increased risk for H.pylori among NS children.

研究背景：幽门螺杆菌（Helicobacter pylori, H.pylori）感染在肾病综合征（Nephrotic syndrome, NS）发病机制中的潜在作用已受到学界广泛关注。研究目的：本研究旨在探讨儿童原发性肾病综合征患者中幽门螺杆菌的感染率、潜在作用及相关危险因素。研究方法：本研究为横断面对照研究，于2017年1月至2019年1月在埃及某大学附属儿童医院开展。共纳入100例原发性肾病综合征患儿（肾病综合征组）与100名健康对照者。对所有受试者进行胃炎症状评估、糖皮质激素治疗应答情况、激素使用剂量及疗程评估。采用幽门螺杆菌粪便抗原（H.pylori stool antigen, HpSA）检测法筛查幽门螺杆菌感染，并检索受试者的肾脏病理检查结果。统计学分析采用卡方检验、Fisher确切概率法及Mann-Whitney检验。研究结果：针对HpSA检测结果，肾病综合征组与健康对照组之间（p=0.193）、糖皮质激素敏感型与糖皮质激素抵抗型肾病综合征亚组之间均未发现统计学显著差异（p=0.286）。肾病综合征组最常见的肾脏病理表现为系膜增生性肾小球肾炎与微小病变型肾病（Minimal Change Disease, MCD）；在幽门螺杆菌阳性患儿中，微小病变型肾病最为多见（9例，占比45%），与幽门螺杆菌阴性患儿相比差异具有统计学意义（p=0.013）。大剂量糖皮质激素使用与肾病综合征患儿幽门螺杆菌感染风险升高相关（优势比[OR]=3.8；95%置信区间[CI]=1.3~11.3）。研究结论：本研究未发现幽门螺杆菌感染参与原发性肾病综合征发病机制的证据。大剂量糖皮质激素使用与肾病综合征患儿幽门螺杆菌感染风险升高显著相关。