细胞毒素相关蛋白A与缺血性脑卒中及亚型相关性研究

Association between ischemic stroke and cytotoxin-associated gene-A-bearing strains of Helicobacter pylori

目的探讨伴细胞毒素相关蛋白A（CagA）阳性幽门螺杆菌（Hp）感染是否为缺血性脑卒中（IS）及其亚型的危险因素。方法纳入123例IS患者，根据2007年改良的TOAST分型标准对卒中进行病因学分型，其中动脉粥佯硬化血栓形成94例、心源性栓塞14例、小动脉卒中12例，同期纳入同社区年龄匹配的131例无心脑血管病的受试者作为对照组。所有纳入对象均记录CagA感染的潜在危险因素及IS相关危险因素。采用酶联免疫吸附法测定血清CagA特异性抗体IgG（CagA—IgG）。比较两组血清CagA—IgG阳性率，分析CagA阳性Hp感染与IS的相关性。采用Logistic回归模型进行多因素分析。结果病例组CagA—IgG阳性率高于对照组，但差异无统计学意义（39．8％vs38．9％，OR=1．039，95％CI：0．628～1．719），校正CagA阳性Hp感染的潜在危险因素及IS相关危险因素后，两者间差异仍无统计学意义（OR=1．062，95％CI20．595～1．895）。进一步行亚型分析，校正相关危险因素后结果示CagA阳性Hp感染与各亚型之间相关性亦无统计学意义：其中动脉粥样硬化血栓形成OR=0．941，95％CI：0．491～1．803；心源性栓塞OR=1．357，95％CI：0．389～4．741；小动脉卒中OR=2．391，95％CI：0．580～9．853。结论CagA阳性Hp感染与IS及其亚型无明显相关性，需更多大样本及高质量的前瞻性研究以进一步探讨。

Objective To analyze the risk role between cytotoxin-associated gene-A（CagA）-bearing strains of Helicobacter pylori（Hp） with different types of ischemic stroke （IS）. Methods The seroprevalence of anti-CagA antibodies was assessed in 123 patients and 131control subjects without history of IS and relevant vascular diseases. Analyses were stratified for etiologic stroke subtypes according to 2007 modified TOAST criteria [ 94 patients with atherothrombosis （ AT）, 14 patients with cardioembolis （CE）, and 12 patients with small arcery disease（SAD） ]. All subjects were recorded potential risk factors for CagA infection and traditional risk factors for IS. The serumal specific antibody CagA-IgG was detected by enzyme-linked immunosorbent assay（ELISA）. CagA-lgG was compared between patients and control subjects,then the risk role of CagA in patients with IS was analyzed. Conditional logistic regression was used. Results A trend toward a higher CagA-lgG was observed in cases with respect to controls without reaching a statistical significance （39. 8% vs 38.9% ,OR： 1. 039,95% CI：0. 628 - 1. 719 ）. This result remained nonsignificant after adjusting for potential risk factors for CagA infection and known risk factors for IS（ OR：I. 062,95% CI：0. 595 - 1. 895 ）. Subgroup analyses yielded similar results in all etiologic stroke subtypes, with the result of muhivariateanalysis ： AT ： OR ： 0. 941,95 % CI ： 0. 491 - 1. 803 ; CE ： OR：1.357,95%CI：0.389-4.741;SAD：OR：2.391,95%CI：0.580-9.853. Conclusions Our case-control study dose not provide evidence of any strong association between CagA-bearing strains of Hp chronic infection and subgroups of IS. There is still need for large case-control and mainly prospective studies investigating the contribution of CagA-bearing strains of Hp infection to stroke risk.