东亚型幽门螺旋杆菌感染与胃癌发生的关系

East-Asian-type of Helicobacter pylori infection and gastric cancer development

目的通过检测各部位慢性胃炎、胃溃疡、胃上皮内瘤变、胃癌幽门螺旋杆菌(Hp)感染情况,探讨河北省消化道肿瘤高发地区Hp感染,特别是东亚型幽门螺旋杆菌(EAS)感染与胃癌发生的关系。方法依据国际最新悉尼系统分级标准和直观模拟评分法对慢性胃炎进行分级;分别应用Giemsa染色和免疫组织化学法检测贲门、胃体、胃窦3个部位Hp和EAS感染情况,分析Hp感染率、部位分布以及与胃癌发生的关系。结果总体结果表明,慢性胃炎和胃溃疡中EAS阳性检出率分别为67.0%(138/206)、100.0%(12/12)明显高于上皮内瘤变43.8%(32/73)和胃癌21.7%(13/60)(P<0.05)。进一步按病变部位分析贲门、胃体、胃窦和EAS阳性检出率,结果发现同一部位中慢性胃炎、胃溃疡、低级别上皮内瘤变、高级别上皮内瘤变、胃癌Hp和EAS阳性率差异无统计学意义(P>0.05)。从慢性胃炎严重程度方面分析,中性粒细胞浸润程度、单核细胞浸润程度、萎缩程度、肠化生程度最严重部位均位于贲门,差异均有统计学意义(P<0.05)。Hp密度最高部位位于胃体(P>0.05),但差异无统计学意义。Spearman相关性分析显示,在贲门、胃体、胃窦,Hp密度分别与中性粒细胞浸润程度、单核细胞浸润程度、萎缩程度、肠化生程度呈正相关(P均<0.05)。结论河北省消化道肿瘤高发地区ESA阳性检出率较高,其感染分别与中性粒细胞浸润深度、单核细胞浸润深度、萎缩程度、肠化生程度呈正相关,且在贲门处较易引起严重病变,贲门癌的发生与ESA感染密切相关。

Objective To explore the relationship between Helicobacter pylori（Hp） infection,especially East-Asian-type Helicobacter pylori（EAS） infection,and the development of gastric cancer by detecting the expression of both common Hp and EAS in chronic gastritis,gastric ulcer,gastric intraepithelial neoplasia and gastric cancer in high risk area of digestive neoplasms of Hebei province.Methods Different stages of chronic gastritis were classified according to both updated Sydney system and visual analog scale,and analyzed by statistics.Both common Hp antibody and EAS antibody were used in immunohistochemistry,and the expression of Hp was detected as a comparison.Results As a whole,the results showed that the EAS positive detection rate in the chronic gastritis and gastric ulcer 67.0%（138/206） and 100.0%（12/12） were significantly higher than intraepithelial neoplasia 43.8%（32/73） and gastric cancer 21.7%（13/60）（P〈0.05）.Further according to the analysis of the lesion site cardia,corpus,antrum and EAS positive detection rate,it was found that the same part in chronic gastritis,gastric ulcer,low level intraepithelial neoplasia,high level intraepithelial neoplasia,stomach Hp and EAS positive rate had no obvious difference（P〉0.05）.The severity of gastritis in this study was analyzed.In cardia,corpus and antrum,statistic significance were found in neutrophils infiltration,mononuclear cells infiltration,atrophy and intestinal metaplasia after using nonparametric test（P〈0.05）.No significant differences were found in Hp density,and the most serious areas of neutrophils infiltration,mononuclear cells infiltration,degree of atrophy,intestinal metaplasia were located in cardia,but Hp density was not.In cardia,corpus and antrum,positive correlation were demonstrated between Hp density and neutrophil infiltration,mononuclear cells infiltration,atrophy degree or intestinal metaplasia by Spearman rank correlation analysis （all P〈0.05）.Conclusion In high risk area of digestive neoplasms of Hebei province,EAS positive detection rate is higher.EAS infection respectively is positively associated with neutrophil infiltration depth,mononuclear cell infiltration depth,the degree of atrophy,intestinal metaplasia,and easier to cause severe disease in cardia.The occurrence of cardia cancer is closely associated with EAS infection.