胆汁反流性胃炎胃黏膜Th1/Th2平衡的研究  

Study on Gastric Mucosal Th1/Th2 Balance in Bile Reflux Gastritis

作　　者：王吉[1] 顾玮[1] 葛心怡[2] 刘进进[1] 马瑾[1] 胡晓莹[1] 胡梅洁[2] 

机构地区：[1]上海交通大学医学院附属瑞金医院卢湾分院消化内科,200020 [2]上海交通大学医学院附属瑞金医院消化内科

出　　处：《胃肠病学》2012年第6期358-362,共5页Chinese Journal of Gastroenterology

摘　　要：背景:胆汁反流性胃炎(BRG)是由过多的十二指肠胃反流引起的胃黏膜化学性炎症,与萎缩、肠化生等胃黏膜癌前病变有关。胃黏膜癌变过程中存在Th1/Th2平衡向Th2方向漂移。目的:探讨BRG的免疫发病机制及其胃黏膜Th1/Th2平衡状态与胃癌的关系。方法:60例原发性BRG患者和38例正常对照者纳入研究。于内镜下行BRG分级,取胃黏膜根据新悉尼系统行组织学变化分级,并以免疫组化方法检测胃黏膜Th1细胞因子干扰素-γ(IFN-γ)和Th2细胞因子白细胞介素4(IL4)表达,分析两者表达与BRG胃黏膜内镜和组织学表现的相关性。结果:BRG胃黏膜中的IFN-γ、IL4阳性表达率均显著高于正常对照组且两者呈负相关(P<0.05),IL4呈高表达而IFN-γ呈低表达(免疫组化评分:2.60±1.83对1.10±1.12)。BRG胃黏膜IFN-γ表达与胃黏膜慢性炎症和活动性呈正相关(P<0.05),与肠化生呈负相关(P<0.05);IL4表达与胃黏膜慢性炎症、活动性、萎缩呈正相关(P<0.05);两者表达均与BRG内镜分级呈正相关(P<0.05)。结论:BRG胃黏膜的Th1/Th2平衡向Th2方向漂移,与胃黏膜癌变过程中的Th1/Th2平衡漂移方向一致;Th2型炎症反应在BRG的发生、发展中起重要作用;Th1极化时胃黏膜不易发生肠化生。Bile reflux gastritis （BRG） is a chemical gastric mucosal inflmmnation caused by excessive duodenogastric reflux and has been reported to be related with precancerous lesions of gastric cancer such as atrophy and intestinal metaplasia. Cytokine secretions shifting from Thl pattern to Th2 pattern was observed in the tumorigenesis of gastric mucosa. Aims： To investigate the immunopathological mechanism of BRG and the relationship of BRG mucosal Thl/Th2 balance with gastric cancer. Methods： A total of 60 primary BRG patients and 38 normal controls were enrolled. The severity of BRG was graded endoscopically, and the histological changes of gastric mucosa were evaluated by the updated Sydney System. Expressions of Thl cytokine interferon-γ （IFN-γ） and Th2 cytokine interleukin-4 （IL-4） in gastric mucosa were determined by immunohistochemistry and their correlations with the endoscopic and histological changes of BRG mucosa were analyzed. Results： Expression rates of IFN-γ and IL-4 in BRG mucosa were significantly higher than those in normal gastric mucosa （P 〈 0.05 ）. These two cytokines were negatively correlated （P 〈 0.05 ）, IL-4 being highly expressed and IFN-γbeing lowly expressed （immunohistochemical score： 2.60± 1.83 vs. 1.10 ±1.12）. In histopathological examination of BRG mucosa, IFN-γ expression was positively correlated with gastric mucosal chronic inflammation and activity and negatively correlated with intestinal metaplasia （P 〈 0.05 ）, while IL-4 expression was positively correlated with gastric mucosal chronic i,fflammation, activity and atrophy （ P 〈 0.05 ）. Both of IFN-γ and IL-4 expressions were positively correlated with the endoscopic grading of BRG （ P 〈 0.05 ）. Conclusions： Thl/Th2 balance in BRG mucosa shifts to Th2 pattern as that occurred in tumorigenesis of gastric mucosa. Th2-type inflammation plays a crucial role in the pathogenesis and development of BRG. Under Thl polarization status, intestinal metaplasia is not easy to occur

关 键 词：胆汁反流 胃炎 干扰素Γ 白细胞介素4 TH1细胞 TH2细胞 

分 类 号：R573.3[医药卫生—消化系统]