慢性胃炎患者口腔幽门螺杆菌对胃幽门螺杆菌根除率的影响

The relationship between Helicobacter pylori in oral cavity and the Hp infection in stomach from chronic gastritis patients

目的明确慢性胃炎患者口腔内幽门螺杆菌(Helicobacter pylori,Hp)对胃幽门螺杆菌根除率的影响。方法选择65例有慢性胃炎症状、并经全口牙周检查有不同程度牙周炎的患者进行胃镜检查,每例均取口腔标本进行Hp检测。对胃Hp感染患者治疗后4周以及1年后分别复查胃Hp的感染状况,Hp检测采用碳13呼气试验。引物选用尿素酶C基因和CagA基因,PCR检测Hp。结果口腔Hp阳性者龈下菌斑与龈上菌斑中的Hp阳性率比较,P<0.01;慢性胃病Hp的检出率与牙周临床指数相关,牙周袋深度(PD)≥4 mm部位菌斑中Hp检出率显著高于PD<4 mm的部位(P<0.05);口腔Hp阳性患者用药4周后的胃Hp根除率稍低于用药前口腔Hp阴性患者(68.0%vs 69%,P>0.05),用药1年后的胃Hp根除率更是显著低于口腔Hp阴性组(32.0%vs 66%,P<0.05)。结论慢性胃病患者胃Hp的根除率受口腔Hp存在的影响;牙周炎患者口腔Hp阳性者的胃Hp根除率显著低于口腔Hp阴性者根除率。

Objective： To analyze the relationship between Helicobacter pylori（Hp） in oral cavity and the Hp infection in stomach. Methods： Sixty-five patients with gastric Hp infection and periodontitis were enrolled in this study. DNA was extracted from subgingival plaques and stomach mucosa samples. To identify the presence of Hp in these samples, PCR （ polymerase chain reaction） was carried out, and two pairs of oligonucleotide primer were used to amplify a portion of gene urease C and gene cag A of Hp. Results： The rate of Hp detected in oral cavity was significantly higher in patients with positive Hp in stomach than that in those with negative Hp in stomach （ P 〈 0. 05 ）. After the treatment for gastric Hp infection for 4 weeks, the eradication rate of Hp in stomach was lower, but only slightly in patients with positive oral Hp （ 68% ） than that in those with negative oral Hp （69 % ）. However, this difference became apparent （32. 0 % vs 66 %, P 〈 0. 05 ） after one year of the treatment. Conclusion： The effectiveness of the eradication therapy for gastric Hp infection is affected by the presence of Hp in oral cavity. Oral colonization of Hp may imply that there is a risk of the relapses of gastric and duodenal Hp infection and ulcer after the antibiotics treatment for the eradication of Hp.