美国幽门螺杆菌血清阳性率相关的环境危险因素：基于NHANES数据的横断面分析

摘要(中文译文)

幽门螺杆菌（Helicobacter pylori）给公共卫生带来了相当大的负担。感染主要在儿童期获得，并可导致慢性疾病，包括胃溃疡和癌症。该细菌可在水中存活，但环境在传播中的作用仍知之甚少。本研究对具有全国代表性的美国国家健康与营养调查（NHANES）进行了分析，以探讨与幽门螺杆菌血清阳性率相关的环境危险因素。研究分析了1999—2000年的数据，并进行加权以代表美国人群。多变量logistic回归估算了与血清阳性率相关的调整比值比（aOR）和95%置信区间（CI）。自评总体健康状况与血清阳性率呈负相关。在年龄<20岁的参与者中，血清阳性率与以水井作为家庭自来水来源（aOR 1.7，95% CI 1.1—2.6）以及居住在更为拥挤的家中（aOR 2.3，95% CI 1.5—3.7）显著相关。在年龄⩾20岁的成年人中，血清阳性率与井水或拥挤的居住条件无关，但与土壤无关职业的成年人相比，从事与土壤相关职业的成年人血清阳性率的比值显著更高（aOR 1.9，95% CI 1.2—2.9）。与未暴露的成年人相比，同时暴露于井水和职业相关土壤增加了成年人血清阳性率比值比的效应量（aOR 2.7，95% CI 1.3—5.6）。环境暴露（使用井水和职业性接触土壤）在幽门螺杆菌传播中发挥作用。感染负担不成比例地与健康状况不佳和拥挤的居住条件相关，但风险因年龄和种族/民族而异。这些发现有助于为减少美国感染负担的干预措施提供依据。

Abstract

Helicobacter pylori imparts a considerable burden to public health. Infections are mainly acquired in childhood and can lead to chronic diseases, including gastric ulcers and cancer. The bacterium subsists in water, but the environment's role in transmission remains poorly understood. The nationally representative National Health and Nutrition Examination Survey (NHANES) was examined for environmental risk factors associated with H. pylori seroprevalence. Data from 1999-2000 were examined and weighted to represent the US population. Multivariable logistic regression estimated adjusted odds ratios (aOR) and 95% confidence intervals (CI) for associations with seropositivity. Self-reported general health condition was inversely associated with seropositivity. Of participants aged <20 years, seropositivity was significantly associated with having a well as the source of home tap water (aOR 1·7, 95% CI 1·1-2·6) and living in a more crowded home (aOR 2·3, 95% CI 1·5-3·7). Of adults aged ⩾20 years, seropositivity was not associated with well water or crowded living conditions, but adults in soil-related occupations had significantly higher odds of seropositivity compared to those in non-soil-related occupations (aOR 1·9, 95% CI 1·2-2·9). Exposures to both well water and occupationally related soil increased the effect size of adults' odds of seropositivity compared to non-exposed adults (aOR 2·7, 95% CI 1·3-5·6). Environmental exposures (well-water usage and occupational contact with soil) play a role in H. pylori transmission. A disproportionate burden of infection is associated with poor health and crowded living conditions, but risks vary by age and race/ethnicity. These findings could help inform interventions to reduce the burden of infections in the United States.

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