幽门螺杆菌感染致萎缩性胃炎患者胃黏膜组织的病理机制及血清学诊断指标临床意义

Pathological mechanism of gastric mucosa of patients with atrophic gastritis caused by Helicobacter pyloriinfections and indicators of serologic diagnosis

目的探讨幽门螺杆菌(HP)感染致萎缩性胃炎患者胃黏膜组织中环氧合酶-2(COX-2)和血清骨桥蛋白(OPN)、胃蛋白酶原Ⅰ、Ⅱ(PGⅠ、Ⅱ)水平检测的临床意义。方法 160例萎缩性胃炎患者随机分为4组,根据病情程度:慢性萎缩性胃炎(CAG组);萎缩性胃炎伴肠上皮化生(IM组);萎缩性胃炎伴不典型增生(DYS组);胃癌(GCA组);选择慢性浅表性胃炎(CSG组)为对照组,13 C-尿素呼气试验用质谱法测定;胃黏膜组织COX-2测定采用免疫组化法;OPN和PGⅠ、Ⅱ水平指标均采用ELISA方法检测。结果 HP感染率CAG组与CSG组比较差异无统计学意义,而CAG组、IM组和DYS组的感染率均显著高于CSG组(均P<0.05),GCA(胃癌)组阳性率升高更为显著(P<0.01),相邻组间差异无统计学意义;COX-2阳性率其余4组均分别显著高于CSG组(P<0.01),相邻组中除CAG组外互相皆差异无统计学意义,血清OPN水平4组较CSG组均显著升高(P<0.05),CAG组和GCA组升高更为显著(均P<0.01);PGⅠ、PGⅡ水平CAG组、IM组和DYS组与CSG组比较和相邻组比较差异均无统计学意义。结论 HP感染可导致胃黏膜病变,COX-2、OPN及PGⅠ和PGⅠ/PGⅡ比值测定,对于CAG和GCA的病理机制和辅助诊断有一定价值。

OBJECTIVE To explore the clinical significance of changes of Helicobacter pylori infection on cyclooxygenase-2 expression in gastric mucosal epithelium and serum OPN,PGⅠ,PGⅡ and PGⅠ/PGⅡlevel in patients with atrophic gastritis.METHODS A total of 160 patients with atrophic gastritis were divided into 4 groups according to the degree of the illness： CAG group,IM group,DYS group,GCA group.CSG were control group.13C-urea breath was tested using mass spectrometry.Their cyclooxygenase-2 expression in gastric mucosal epithelium was determined with immunohistochemistry（IHC）.Serum levels of OPN,PGⅠ,Ⅱ were determined by with enzyme immunoassay.The data were processed and analyzed.RESULTS The positive rate of HP was significant higher in patients with IM as well as DYS and GCA than those in the controls（P0.05）,but CAG group showed no significant difference,the difference was not statistically significant.The positive rate of cyclooxygenase-2 expression in gastric mucosal epithelium were also significantly higher in all the patients than those in the controls（P0.01）,there were no statistical differences in CAG,IM,DYS and GCA.The positive rate of HP in the patient groups（CAG＋ IM ＋ DYS,GCA）were positively correlated with cyclooxygenase-2 expression in gastric mucosal epithelium（P0.01）.while CAG and GCA were extraordinary higher,in adjacent patient groups were mutually significant difference（all P0.05）,besides only DYS became not significant difference from IM.PG Ⅰ,PG Ⅱlevels were not significantly different in CAG group,IM group,the DYS group,and the CSG group as the adjacent groups;PGⅠ/ PGⅡratio showed no statistical difference（P0.01） within GCA and CAG group.CONCLUSION The atrophic gastritis is positively correlated with H.pylori infection,the determination of changes of serum OPN,PGⅠ and PGⅠ/PGⅡmight be useful for pathogenesis and clinical diagnosis of atrophic gastritis and GCA.