目的研究2型糖尿病(T2DM)患者中幽门螺杆菌(Hp)感染与胰岛素抵抗(HOMA-IR)的关系,为T2DM的临床治疗提供理论依据。方法选择2013年3月至2016年3月于丽水市中心医院内分泌科就诊的321例T2DM患者为研究对象,采用13C尿素呼气试验,将患者分为Hp阳性组和Hp阴性组,对所有患者进行空腹血糖(FPG)和空腹胰岛素(FINS)测定,计算体质指数(BMI)和HOMA-IR。选择不同年龄和BMI的T2DM患者,比较Hp阳性组和Hp阴性组的HOMA-IR;将78例年龄<45岁、BMI<25 kg/m~2的T2DM合并Hp感染患者随机分为A和B两组,各39例,B组作为对照组只通过控制饮食、口服药物和注射胰岛素进行常规治疗,A组在B组的基础上进行三联根除Hp治疗。测定两组HOMA-IR、甘油三酯(TG)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)和高敏C反应蛋白(hs-CRP)。用SPSS 17.0软件进行统计分析,两组计量资料的比较用t检验。结果与Hp阴性组相比,Hp阳性组中,患者年龄<45岁或者BMI值<25 kg/m~2时,HOMA-IR较高且差异有统计学意义(P<0.05);患者年龄≥45岁或者BMI值≥25 kg/m~2时,HOMA-IR差异无统计学意义(P>0.05)。选择年龄<45岁,BMI<25 kg/m~2的患者,Hp阳性组78例,Hp阴性组48例,与Hp阴性组[(21.31±2.56)kg/m~2]相比,Hp阳性组BMI[(23.95±2.32)kg/m~2]偏高,但差异无统计学意义(t=0.832,P>0.05),Hp阳性组HOMA-IR(1.76±0.42)明显高于Hp阴性组(1.13±0.16),差异有统计学意义(t=5.941,P<0.05)。A组HOMA-IR、TG和hs-CRP水平明显低于B组,差异均有统计学意义(P<0.05),两组TC、HDL-C和LDL-C水平的差异均无统计学意义(P>0.05)。结论 Hp感染会促进T2DM患者的HOMA-IR,针对Hp感染采取治疗可改善T2DM患者的症状。 Objective To investigate the relationship between Helicobacter pylori (Hp) infection and insulin resistance (HOMA-IR) in type 2 diabetes mellitus (T2DM) patients and provide a theoretical basis for the clinical treatment of T2DM. Methods From March 2013 to March 2016, 321 T2DM patients treated in Department of Endocrinology of Central Hospital of Lishui City were selected as study subjects. Patients were divided into Hp-positive group and Hp-negative group by 13C urea breath test. All patients Fasting plasma glucose (FPG) and fasting insulin (FINS) were measured to calculate body mass index (BMI) and HOMA-IR. HOMA-IR was compared between Hp-positive and Hp-negative T2DM patients of different ages and BMI. A total of 78 patients with age-45 and BMI <25 kg / m ~ 2 were randomly divided into A and B The two groups, 39 cases each, group B as the control group only through the control diet, oral medication and insulin injections for routine treatment, group A in group B on the basis of triple eradication Hp treatment. The levels of HOMA-IR, triglyceride (TG), total cholesterol (TC), high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C) and high sensitivity C-reactive protein ). SPSS 17.0 software for statistical analysis, the two sets of measurement data were compared using t test. Results Compared with Hp negative group, HOMA-IR was higher and the difference was statistically significant (P <0.05) in patients with Hp positive group, age <45 years or BMI <25 kg / m ~ 2; 45 years old or BMI value ≥25 kg / m ~ 2, HOMA-IR had no significant difference (P> 0.05). Eighty-eight Hp-positive patients and 48 Hp-negative patients with age <45 years and BMI <25 kg / m 2, compared with Hp negative patients (21.31 ± 2.56 kg / m 2) (23.95 ± 2.32) kg / m 2], but the difference was not statistically significant (t = 0.832, P> 0.05). The HOMA-IR of Hp positive group was significantly higher than that of Hp negative group (1.13 ± 0.16), the difference was statistically significant (t = 5.941, P <0.05). The levels of HOMA-IR, TG and hs-CRP in group A were significantly lower than those in group B (P <0.05). There were no significant differences in the levels of TC, HDL-C and LDL-C P> 0.05). Conclusion Hp infection can promote HOMA-IR in T2DM patients, and the treatment of Hp infection can improve the symptoms of T2DM patients.