幽门螺杆菌感染对功能性消化不良病儿发病的影响  

EFFECT OF HELICOBACTER PYLORI INFECTION ON THE PATHOGENESIS OF FUNCTIONAL DYSPEPSIA IN CHILDREN

作　　者：姚珊珊[1] 杨林[2] 田字彬[2] 张翠萍[2] 杨鑫 韩磊[3] YAO Shanshan;YANG Lin;TIAN Zibin;ZHANG Cuiping;YANG Xin;HAN Lei(The Affiliated Hospital of Qingdao University , Qingdao 266003, China)

机构地区：[1]青岛大学附属医院临床技能培训中心,山东青岛266003 [2]青岛大学附属医院消化内科,山东青岛266003 [3]青岛大学附属医院营养科,山东青岛266003

出　　处：《青岛大学学报（医学版）》2019年第3期257-261,共5页Journal of Qingdao University(Medical Sciences)

基　　金：国家自然科学基金面上项目(81572320)

摘　　要：目的探讨幽门螺杆菌(HP)感染对功能性消化不良(FD)病儿发病机制的影响。方法收集诊断为FD的病儿100例,确定其消化不良症状的严重程度并进行评分,行13C尿素呼气试验明确HP感染情况。根据HP检测结果将病儿分为HP阳性组与HP阴性组,对HP阳性组病儿检测其毒力因子细胞毒素相关蛋白A(CagA)抗体,根据其结果进一步分为CagA阳性组与CagA阴性组。应用酶联免疫吸附试验(ELISA)方法检测各组病儿血清中相关胃肠激素的表达水平;行胃镜检查时取胃黏膜组织进行苏木精-伊红(HE)染色,对胃黏膜炎症程度进行评分并观察炎性细胞浸润情况;行实时荧光定量PCR检测胃黏膜中相关炎症因子与趋化因子mRNA的表达水平。以健康查体儿童100例作健康对照。结果 FD病儿HP感染率(60%)显著高于健康对照儿童(15%),差异有显著性(χ^2=43.2,P<0.01)。HP阳性组CagA阳性者占80%,与CagA阴性组、HP阴性组相比,CagA阳性组病儿的消化不良症状积分明显增高(F=91.26,q=6.73、19.08,P<0.01),胃黏膜炎症程度与炎性细胞浸润亦明显增加;血清5-羟色胺与瘦素水平明显降低,促胃液素与胃促生长素水平明显增高,差异均有显著意义(F=622.35~3 724.33,q=5.29~122.04,P<0.01);胃组织中炎症因子IL-17、INF-γ与趋化因子CXCL13、CCL2的mRNA表达水平均显著增高,差异有统计学意义(F=413.72~842.75,q=16.11~57.98,P<0.01)。结论 HP感染可能是儿童FD的重要致病因素之一;HP感染可能通过CagA的作用影响胃肠激素的分泌与局部黏膜免疫反应而参与FD的发病。Objective To investigate the effect of Helicobacter pylori (HP) infection on the pathogenesis of functional dyspepsia (FD) in children. Methods A total of 100 children diagnosed with FD were enrolled. The severity of dyspepsia was determined and scored, and the 13 C-urea breath test was performed to identify HP infection. According to the results of HP detection, the children with FD were divided into HP-positive group and HP-negative group. Based on the results of cytotoxin-associated protein A (CagA) antibody detection, the children in the HP-positive group were further divided into CagA-positive group and CagA- negative group. ELISA was used to measure the expression of related gastrointestinal hormones in serum. Gastroscopy was performed to collect gastric mucosa for HE staining, the degree of gastric mucosal inflammation was determined, and the infiltration of inflammatory cells was observed. Quantitative real-time PCR was used to measure the mRNA expression of associated inflammatory cytokines and chemokines in gastric mucosa. A total of 100 healthy children who underwent physical examination were enrolled as healthy control group. Results The children with FD had a significantly higher HP infection rate than the healthy children (60% vs 15%,χ^2=43.2, P <0.01). In the HP-positive group, the children with positive CagA accounted for 80%. Compared with the CagA-negative group and the HP-negative group, the CagA-positive group had a significantly higher symptom score of dyspepsia (F =91.26, q =6.73 and 19.08, P <0.01), significant increases in the degree of gastric mucosal inflammation and the infiltration of inflammatory cells, significant reductions in the serum levels of 5-hydroxytryptamine and leptin, and significant increases in the levels of gastrin and ghrelin (F =622.35-3 724.33, q =5.29-122.04, P <0.01). Compared with the CagA-negative group and the HP-negative group, the CagA-positive group had significant increases in the mRNA expression of the inflammatory cytokines interleukin-17 and interferon-�

关 键 词：消化不良 幽门螺杆菌 胃肠激素 趋化因子类 

分 类 号：R725.7[医药卫生—儿科]