Impacto da infecção por Helicobacter pylori na glicemia e resistência à insulina de pacientes com sintomas dispépticos

Abstract

Studies have shown that Helicobacter pylori infection increases the incidence of metabolic diseases, but the correlation between H. pylori infection and glycemic disorders have produced varied and controversial results. The objective of this study was to analyze the relationship between the presence of H. pylori infection with glycemia and triglyceride-glucose index in patients with dyspeptic symptoms. This is a cross-sectional study conducted with dyspeptic patients who were indicated to undergo upper digestive endoscopy. Interviews were conducted to collect socioeconomic data, anthropometric evaluation, and peripheral blood collection for laboratory tests, in addition to reviewing medical records to investigate endoscopic diagnoses and H. pylori infection. Fasting glycemia, glycated hemoglobin, and triglycerides were measured in peripheral blood samples collected after an 8-hour fast. Glycemic classification parameters followed the recommendations of the Diretrizes da Sociedade Brasileira de Diabetes 2019-2020. The triglyceride-glucose index was calculated to investigate insulin resistance. Pearson's Chi-squared test was applied to verify the association between variables, and their effect was measured through odds ratio. The Mann-Whitney test was used to compare variables. Spearman's correlation coefficient was used to correlate the outcome of H. pylori infection with raw glycemic biomarker data. A p-value < 0.05 was considered statistically significant. The study was approved by the Human Research Ethics Committee, protocol. 3,212,699. One-hundred dyspeptic patients treated at a public Endoscopy Service in Northeastern Brazil were analyzed. Male patients, those under 45 years old, smokers, and those with less than 8 years of schooling presented higher triglyceride-glucose index indices. Those under 45 years old had higher fasting glycemia levels. Regarding glycated hemoglobin parameters, patients under 45 years old and smokers had the highest glycated hemoglobin serum levels. Dyspeptic patients with body mass index greater than 25kg/m2 , elevated neck circumference parameters, and elevated waist circumference presented the highest triglyceride glucose index indices. Those with elevated waist circumference parameters and waist-hip ratio had higher glycated hemoglobin levels. Patients diagnosed with pangastritis had higher fasting glycemia levels. Patients not infected with H. pylori had elevated triglyceride-glucose indexes and higher fasting glycemia levels compared to those not infected with the bacterium. Regarding glycemic biomarkers, a positive and statistically significant relationship was observed between plasma glycemia and the presence of H. pylori. When studying the density of these findings, it was found that in those with a positive infection for H. pylori, there was a higher concentration of data at lower glycemia values compared to negative cases. Moreover, the presence of outliers is higher in the data of healthy patients. No correlation was observed between glycated hemoglobin levels and H. pylori infection. A statistically significant correlation was found between the triglyceride-glucose index and the presence of H. pylori infection. Patients infected with H. pylori had lower triglyceride-glucose index values than those not infected with H. pylori. In conclusion, hyperglycemia and insulin resistance in dyspeptic patients are influenced by sex, age, education, smoking, and distribution of body fat and are not related to H. pylori infection. Therefore, including the verification of glycemic parameters in the healthcare of dyspeptic patients will contribute to screening for hyperglycemia and prevention of complications such as diabetes.