CagA基因幽门螺杆菌感染在非酒精性脂肪性肝病发生发展的作用  

The role of CagA-positive helicobacter pylori infection in the development of nonalcoholic fatty liver disease

作　　者：彭程 王营 PENG Cheng;WANG Ying(Fuzhou Medical University,Xuzhou 221002,China;Department of Gastroenterology,Xuzhou Medical University Affiliated Hospital,Xuzhou 221000,China)

机构地区：[1]徐州医科大学,江苏徐州221002 [2]徐州医科大学附属医院消化内科,江苏徐州221000

出　　处：《中国中西医结合消化杂志》2019年第6期461-465,共5页Chinese Journal of Integrated Traditional and Western Medicine on Digestion

摘　　要：[目的]探讨细胞毒相关基因A(CagA)幽门螺杆菌(Hp)感染在非酒精性脂肪性肝病(NAFLD)发生发展的作用。[方法]分析徐州医科大学附属医院体检中心行14C-呼气试验测定CagA蛋白及腹部彩超健康体检者317例,依据彩超检查结果分为NAFLD组160例和非NAFLD组157例,进一步将NAFLD患者根据14C-呼气试验测定CagA蛋白表达将患者分为Hp阳性组[Hp(+)组,包括CagA(+)组和CagA(-)组]和Hp阴性组[Hp(-)组]。收集体检者的病史资料、生化指标,计算NAFLD组的APRI、FIB4、NFS肝纤维化评分。[结果]脂肪肝组Hp感染、CagA(+)Hp感染分别为98例(61.3%)、64例(40.0%),非NAFLD组分别为67例(42.7%)、23例(14.6%),差异有统计学意义(P<0.05)。Logistic回归分析中,体重指数(BMI)、超敏C反应蛋白(hs-CRP)、CagA(+)Hp感染与NAFLD的密切相关(OR分别为1.629、1.678、2.596,P<0.05)。CagA(+)组患者的APRI、FIB4、NFS均高于CagA(-)组、Hp(-)组,差异有统计学意义(P均<0.05),Hp(-)组、CagA(-)组差异均无统计学意义。Hp(+)组患者血清LDL水平高于Hp(-)组,差异有统计学意义(P<0.05),Hp(+)组血清CHOL水平高于Hp(-)组,差异有统计学意义(P<0.05)。[结论]CagA(+)Hp感染是NAFLD的独立危险因素,且可能是NAFLD向肝纤维化进展的促进因素。[Objective]To investigate the role of cytotoxic associated gene A(CagA)in the development of Helicobacter pylori(Hp)infection in nonalcoholic fatty liver disease(NAFLD).[Methods]Analysis of 317 cases of examining 14C-breath test,CagA protein and abdominal color doppler health check up in Xuzhou medical university physical examination center.According to the results of color doppler ultrasound examination,the subjects were divided into 160 NAFLD group and 157 non-NAFLD group.The medical history and biochemical indexes of the subjects were collected to calculate the APRI,FIB4 and NFS hepatic fibrosis scores of the NAFLD group.[Results]There were 98 cases(61.3%)and 64 cases(40.0%)of Hp infection and CagA(+)Hp infection in the NAFLD group,67 cases(42.7%)and 23 cases(14.6%)in the control group(P<0.05).Logistic regression analysis showed that BMI,hs-CRP,and CagA(+)Hp infection were closely related to NAFLD(OR were 1.629,1.678 and 2.596,P<0.05,respectively).The NAFLD patients were further divided into Hp(-)group,CagA(+)group and CagA(-)group.APRI,FIB4 and NFS of the patients in the CagA(+)group were[(0.46±0.29)(1.51±0.61)(-1.17±1.26)],which were all higher than those in the CagA(-)group[(0.33±0.12)(1.18±0.46)(-2.00±1.05)]and Hp(-)group[(0.34±0.16)(1.28±0.46)(-1.79±0.95)].The differences were statistically significant(P<0.05),and there were no statistically significant differences between the Hp(-)group and the CagA(-)group.The serum LDL level of the Hp(+)group\[including the CagA(+)group and the CagA(-)group\]was(3.42±0.71)mmol/L and(3.46±0.81)mmol/L,respectively,higher than that of the Hp(-)group(3.14±0.60)mmol/L,P=0.039.The serum CHOL level of the Hp(+)group was(5.61±1.08)and(5.68±1.14)mmol/L,higher than that of the Hp(-)group(5.25±0.91)mmol/L,P<0.05).[Conclusion]CagA(+)Hp infection is an independent predictor of NAFLD and may be a contributing factor in the progression from NAFLD to hepatic fibrosis.

关 键 词：幽门螺杆菌 CAGA蛋白 非酒精性脂肪性肝病 肝纤维化水平 血脂代谢 

分 类 号：R573.6[医药卫生—消化系统]