细胞毒素相关基因A阳性幽门螺杆菌感染与脑梗死的关系

The Relationship Between Cytotoxin-Associated Gene-A Positive Heficobacter Pylori Strains Infection and Cerebral Infarction

目的：研究幽门螺杆菌（HP）及其细胞毒素相关蛋白A（CagA）阳性菌株感染与脑梗死的相关性。方法：采用病例对照研究研究，选择发病1周内的脑梗死住院患者（病例组，n=70）以及年龄和性别相匹配的门诊体检人群（对照组，n=30），检测血清HP IgG抗体和HPCagA阳性菌株IgG抗体的浓度和阳性率，调查两组传统高危因素分布情况、生活习惯、幼时和成人期社会经济状况，探讨HP和CagA阳性菌株血清抗体浓度和阳性率与脑梗死及其病因学亚型的关系。结果：病例组血清HPIgG抗体阳性率和水平与对照组无显著差异，血清CagAIgG抗体阳性率（P〈0．05）和浓度（P〈0．01）均显著高于对照组。多因素回归分析显示，CagA菌株血清学阳性为脑梗死发病的独立危险因素。亚组分析表明，大动脉粥样硬化性脑梗死组血清CagA菌株IgG抗体的阳性率和浓度显著高于对照组（P〈0．05）。结论：产CagA的高毒力HP菌株感染可能是脑梗死的高危因素。

Lin Yin Abstract Objective： To study the correlation betwen Helicobacter pylori （HP） and its cytotoxin-associated gene-A （CagA） positive strains infection and cerebral infarction. Methods： Seventy inpatients with cerebral infarction within one week of onset of symptoms （patient group） and 30 age- and sex-matched individuals accepted the physical examination in outpatient clinic （control group） were selected in the case-control study. The levels and positive rates of serum IgG antibodies against HP and IgG antibodies of CagA-positive HP strains were detected. The distribution of traditional high-risk factors, lifestyle, and socioeconomic status in childhood and adulthood were investigated, and the relationship between serum antibody levels and positive rates of HP and CagA positive strains and cerebral infarction and its etiological subtypes were discussed. Results： There was no significant difference in the positive rates and levels of serum IgG antibodies against HP between the patient and control groups. Both the positive rates （P 〈 0.05） and levels （P 〈0.01） of serum CagA IgG antibodies were significantly higher in the patient group than those in the control group. Multivariate regression analysis indicated that serum positive CagA strains were an independent risk factor for cerebral infarction. Subgroup analysis suggested that the IgG antibody positive rates and levels of serum CagA strains in large artery atherosclerotic cerebral infarction group were significantly higher than those in the control group （P 〈 0.05）. Conclusion： Infection of more virulent HP strains, such as CagA, may be the high-risk factor of cerebral infarction.