隆起糜烂性胃炎证型与幽门螺杆菌感染及热休克蛋白60和70表达的相关性

Relationship among the traditional chinese medicine syndrome-type,Helicobacter pylori infection,and the expression of Heatshock protein60 and protein70

[目的]探讨隆起糜烂性胃炎(Raised Erosive Gastritis,REG)中医证型与幽门螺杆菌(Hp)感染和病理组织学及热休克蛋白60(HSP60)、热休克蛋白70(HSP70)表达的关系,以期指导中西医结合防治REG。[方法]选择131例REG患者按中医辨证分为脾胃湿热证32例(Hp阳性19例,阴性13例),脾胃气虚证52例(Hp阳性者34例,阴性18例),脾虚湿热证47例(Hp阳性者33例,阴性14例)。所有受试者均行胃镜检查,取胃窦部活检标本行快速尿素酶试验及组织染色法检测Hp;病理组织学检查及免疫组织化学检测HSP60,其中63例免疫组织化学检测HSP70。并设正常对照(正常)组18例。[结果]REG脾虚湿热证组的萎缩、肠化生(IM)程度均高于脾胃湿热证及脾胃气虚证组(P<0.05),而后2组之间比较以及3组中Hp阳性者与阴性者比较差异均无统计学意义(P>0.05)。3组HSP60表达均较正常组增加(P<0.01),而3组之间比较均P>0.05;脾胃湿热证及脾虚湿热证组中Hp阳性者的HSP60表达均高于Hp阴性者(P<0.05),而脾胃气虚组中的Hp阳性与Hp阴性者比较P>0.05。3组的HSP70表达均较正常组增加(P<0.01);而3组的HSP70阳性表达情况分别比较均P>0.05;脾胃湿热证组中Hp阴性的HSP70表达高于Hp阳性者(P<0.05),而脾胃气虚证组与脾虚湿热证组中Hp阳性者与阴性者HSP70表达比较均P>0.05。REG Hp阳性者胃黏膜HSP60的表达明显高于Hp阴性(P<0.01);REG Hp阳性者胃黏膜HSP70的表达与Hp阴性者比较P>0.05。[结论]REG脾虚湿热证患者胃黏膜萎缩、IM程度均高于脾胃气虚证及脾胃湿热证。REG3组胃黏膜HSP60及HSP70的表达均较正常组增强。Hp感染可诱导胃黏膜HSP60的高表达。HSP60表达既与Hp感染有关,又与湿热之邪有关。

[Objective]To study the relationship between the traditional chinese medicine syndrome-type and conditions,including Helicobacter pylori（HP）infection,histopathology,and expressions of Heat shock protein60（HSP60）and Heat shock protein70（HSP70）.The aim is to assist treatments of Raised Erosive Gastritis（REG）with combined Traditional Chinese and Western Medicine.[Methods]One hundred and thirty-one patients with REG were selected,being distributed into groups accroding to TCM dialectics,including dampness heat（SSDH）,spleen deficiency dampness heat（SDDH）and spleen stomach qi-deficiency（SSQD）.There were 32 patients in SSDH group（19 cases with Hp positive and 13 cases with Hp negative）;52 patients in SSQD group（34 with Hp positive and 18 with Hp negative）;47 patients in SDDH group（33 cases with Hp positive and 14 cases with Hp negative）.Samples of all patients were obtained from the gastric antrum during the gastroscopy examination.Then tests were runned for detecting the existence of Hp with rapid urease test and staining,and for confirming the expression of HSP60 in immunohistochemistry and pathohistology.63 samples received immunohistochemistry test,including 17 from SSDH group（9 with Hp positive and 8 with Hp negative）,16 from SSQD group（12 with Hp positive and 4 with Hp negative）and 30 from SDDH group（21 with Hp positive and 9 cases with Hp positive）.There were 18 persons without REG in control group.[Results]The degree of atrophy and intestinal metaplasia in the SDDH group was much higher than those of SSQD group and SSDH group（P0.05）,while difference of degree between the latter two groups or between the HP positive cases and Hp negative cases were both without statistical significance（P0.05）.The expression of HSP60 increased in three groups with REG versus the control group（P0.01）,difference of which seemed to be without significance within three groups with REG（P0.05）.HSP60 expression increased in HP positive cases versus Hp negative cases（P0.05）in both SSDH and SDDH groups,while the difference Hp positive cases and Hp negative cases was of no significance in SSQD group（P0.05）.The expression of HSP70 increased in three groups with REG versus the control group（P0.01）,while being of no significance within three groups with REG（P0.05）.The expression of HSP70 increased in HP negative cases versus the Hp positive cases（P0.05）in SSDH group.While there was no obvious difference between Hp positive group and Hp negative group in both SSQD group and SDDH group（P0.05）.The expression of HSP60 increased in Hp positive cases versus Hp negative cases（P0.01）within patients with REG,But results of HSP70 in HP positive cases is not significantly different from that in HP negative cases（P0.05）.[Conclusion]The degree of atrophy and intestinal metaplasia is significantly higher in the SDDH group over both SSQD and SSDH groups.Expressions of HSP60,HSP70 increase in three groups with REG versus the control group.The Hp infection may induce higher expression of HSP60.The expression of HSP60 is associated with the Hp Infection as well as damp heat evil.