血清幽门螺杆菌抗体分型与胃部疾病的关系研究  

Relationship between Types of Serum Antibodies Against H.pylori and Gastric Diseases

作　　者：何媛 赵晶 林泳[1] HE Yuan;ZHAO Jing;LIN Yong(Department of Gastroenterology/Guangzhou Center of Digestive Diseases,Guangzhou First People's Hospital,Guangzhou Medical University,Guangzhou 510180,China;School of Public Health,Guangzhou Medical University,Guangzhou 510000,China)

机构地区：[1]广州医科大学附属广州市第一人民医院消化内科广州消化疾病中心,广东省广州市510180 [2]广州医科大学公共卫生学院,广东省广州市510000

出　　处：《中国全科医学》2019年第36期4424-4428,共5页Chinese General Practice

基　　金：广东省中医药局科研项目(20171182)

摘　　要：背景 我国幽门螺杆菌(H.pylori)感染率较高,但并非所有感染者存在着相同的临床结局,这除了与宿主遗传因素及环境因素相关外,可能还与H.pylori菌株基因型有关.目的 探讨血清H.pylori抗体分型与不同胃部疾病的关系及其临床意义.方法 纳入2009年1月-2017年12月在广州医科大学附属广州市第一人民医院行胃镜检查并同期进行血清H.pylori抗体检测的患者2650例,根据胃镜及病理结果分为五组,其中慢性非萎缩性胃炎组1011例、慢性非萎缩性胃炎伴糜烂组468例、胃溃疡组795例、慢性萎缩性胃炎/不典型增生组236例、胃癌组140例.入选患者均未曾行H.pylori根除治疗,采用蛋白芯片法对H.pylori特异性抗体CagA、VacA和Ure进行血清学检测.统计分析H.pylori感染率、H.pylori分型与不同胃部疾病之间的关系.结果 各组H.pylori阳性率从高到低依次为慢性萎缩性胃炎/不典型增生组(74.58%)、胃溃疡组(74.34%)、胃癌组(72.14%)、慢性非萎缩性胃炎伴糜烂组(71.58%)和慢性非萎缩性胃炎组(64.49%),各组H.pylori感染率比较,差异有统计学意义(P<0.05).共检出H.pyloriⅠ型感染者1596例,H.pyloriⅡ型感染者259例.各组H.pyloriⅠ型阳性率均高于H.pyloriⅡ型,差异有统计学意义(P<0.05).各组H.pyloriⅠ型阳性率比较,差异有统计学意义(χ2=22.586,P<0.01);其中胃溃疡组H.pyloriⅠ型阳性率高于慢性非萎缩性胃炎/不典型增生组(P<0.005).1596例H.pyloriⅠ型患者中,以CagA+VacA抗体为主,占60.15%(960/1596),其次为VacA抗体,占34.27%(547/1596),CagA抗体占5.58%(89/1596).各组CagA+VacA抗体阳性率均高于本组CagA、VacA抗体阳性率,VacA抗体阳性率均高于本组CagA抗体阳性率(P<0.05).各组CagA抗体阳性率比较,差异有统计学意义(χ2=19.054,P<0.01);其中胃溃疡组高于慢性非萎缩性胃炎组(P<0.005).各组VacA抗体阳性率比较,差异有统计学意义(χ2=20.204,P<0.01);其中慢性非萎缩性胃炎组低于慢�Background The prevalence of Helicobacter pylori(H.pylori)infection is high in China.But the clinical outcomes differ in the infectors,which may be associated with genetic and environmental factors,as well as the genotype of H.pylori.Objective To explore the clinical significance of relationship between types of serum antibodies against H.pylori and gastric diseases.Methods A total of 2650 patients who underwent gastroscopy and H.pylori serum antibody test in Guangzhou First People's Hospital,Guangzhou Medical University,from January 2009 to December 2017 were enrolled after excluding those with previous H.pylori eradication treatment.Patients were divided into five groups based on gastroscopy and pathological results:chronic non-atrophic gastritis group(1011 cases),chronic non-atrophic gastritis with erosion group(468 cases),gastric ulcer group(795 cases),chronic atrophic gastritis/dysplasia group(236 cases),and gastric cancer group(140 cases).No H.pylori eradication therapy was performed in the selected patients.Serum H.pylori-specific antibodies CagA,VacA and Ure were detected by protein array.The associations of H.pylori prevalence and H.pylori types with different gastric diseases were compared among five groups.Results The prevalence of H.pylori was 74.58%,74.34%,72.14%,71.58%and 64.49%for chronic atrophic gastritis/dysplasia,gastric ulcer,gastric cancer,chronic non-atrophic gastritis with erosion and chronic non-atrophic gastritis groups,respectively,showing a significant intergroup difference(P<0.05).A total of 1596 cases of H.pylori typeⅠstrains infection and 259 cases of typeⅡstrains infection were detected.The prevalence of H.pylori typeⅠstrains was significantly higher than that of typeⅡin all the groups(P<0.05).The prevalence of H.pylori typeⅠdiffered significantly in each group(χ2=22.586,P<0.01).The prevalence of H.pylori typeⅠstrains in gastric ulcer group was higher than that in chronic non-atrophic gastritis/dysplasia group(P<0.005).Among the 1596 patients with H.pylori typeⅠstrain

关 键 词：幽门螺杆菌 幽门螺杆菌抗体 细胞毒素相关基因A 细胞空泡毒素 尿素酶 胃部疾病 

分 类 号：R573.3[医药卫生—消化系统]