结直肠腺瘤组织幽门螺杆菌富集与腺瘤临床及病理特征的相关性  

Correlation between Helicobacter pylori enrichment and clinical and pathological characteristics of colorectal adenoma

作　　者：庄肇朦 余炳取 谢敏[1] 张益光[1] Zhuang Zhaomeng;Yu Bingqu;Xie Min;Zhang Yiguang(Department of Gastroenterology,Wenzhou Integrated Hospital of Traditional Chinese and Western Medicine affiliated to Zhejiang University of Traditional Chinese Medicine,Wenzhou 325001 China)

机构地区：[1]浙江中医药大学附属温州中西结合医院消化科,温州325001

出　　处：《中华医学杂志》2022年第44期3543-3548,共6页National Medical Journal of China

基　　金：浙江省温州市医药卫生科学研究基金项目(Y20190609)。

摘　　要：目的观察结直肠腺瘤患者腺瘤组织幽门螺杆菌(Hp)富集情况,分析其与结直肠腺瘤临床及病理特征间的相关性。方法回顾性收集2019年1月至2021年6月浙江中医药大学附属温州中西结合医院内镜中心1622例胃肠镜检查者的资料。比较结直肠腺瘤组(743例)和检查阴性对照组(879例)的一般资料、胃黏膜Hp感染情况、结直肠腺瘤临床及病理特征、腺瘤Hp甲基蓝特殊染色、腺瘤Hp免疫组化染色结果,腺瘤人Toll样受体5(TLR5)蛋白免疫荧光结果。结果结直肠腺瘤组共743例,年龄(54.5±12.3)岁,男性占56.0%(416/743)。对照组共879例,年龄(55.6±12.1)岁,男性占58.4%(513/879)。结直肠腺瘤组胃Hp阳性361例(48.6%),对照组胃Hp阳性331例(37.7%),差异具有统计学意义(P<0.001)。胃黏膜Hp感染与腺瘤组织Hp富集存在明显相关性(OR=28.590;95%CI:18.554~44.055,P<0.001)。同时发现结直肠腺瘤Hp富集与腺瘤数目、直径、腺瘤病理类型、腺瘤恶性度等存在相关性(RR=0.804、3.163、3.089、2.463,均P<0.001),且发现Hp富集的腺瘤组织TLR5蛋白表达增高。结论胃Hp感染与结直肠腺瘤Hp富集事件相关,而腺瘤组织Hp富集与腺瘤的临床及病理特征之间具有相关性,其促瘤作用可能与Hp上调黏膜TLR5蛋白表达有关。Objective Aim to observe the enrichment of Helicobacter pylori(Hp)in adenoma tissue of patients with colorectal adenoma and analyze its effect on the clinical and pathological characteristics of colorectal adenoma.Methods The data of 1622 cases of gastroenteroscopy in the Endoscopy Center of Wenzhou Integrated Traditional Chinese and Western Medicine Hospital Affiliated to Zhejiang University of Traditional Chinese Medicine from January 2019 to June 2021 were collected retrospectively.The general data,gastric HP infection,clinical and pathological features,HP methyl blue special staining,HP immunohistochemical staining and toll-like receptor5(TLR5)protein immunofluorescence of colorectal adenomas were compared between the colorectal adenoma group(743 cases)and the control group(879 cases).Results There were 743 cases in the colorectal adenoma group,aged(54.5±12.3)years,and 56.0%were male.There were 879 cases in the control group,aged(55.6±12.1),and 58.4%were male.Gastric Hp was positive in 361 cases in the colorectal adenoma group with a positive rate of 48.6%and in 331 cases in the control group with a positive rate of 37.7%.The difference was statistically significant(P<0.001).Gastric HP infection significantly increased the risk of Hp enrichment in colorectal adenomas(OR=28.590;95%CI:18.554-44.055;P<0.001).At the same time,Hp enrichment in colorectal adenomas was the promoting factor of positive events in adenoma diameter,pathological adenoma type,and adenoma malignancy(RR=0.804,3.163,3.089,2.463,P<0.001).It was also found that the expression of TLR5 protein was increased in HP-enriched adenomas.Conclusion There is a positive correlation between gastric HP infection and intestinal HP enrichment.The effect of intestinal HP enrichment on the clinical and pathological characteristics of colorectal adenoma is statistically significant,and its tumor-promoting effect may be related to the upregulation of mucosal TLR5 protein.

关 键 词：结直肠肿瘤 结直肠腺瘤 幽门螺杆菌 腺瘤病理类型 TOLL样受体5 

分 类 号：R735.34[医药卫生—肿瘤]