胆囊结石与胆囊壁黏膜幽门螺杆菌定植的关系

Relationship between gallbladder stones and Helicobacter pylori colonization of the gallbladder mucosa

目的:研究和探讨幽门螺旋杆菌(Helicobacter pylori,H.pylori)在胆囊壁黏膜中的定植与胆囊结石形成的相关性.方法:分别对结石性胆囊炎和非结石性胆囊切除患者的胆囊组织和胆汁进行幽门螺杆菌检测,采用多聚酶链式反应检测幽门螺杆菌特异性DNA片段、酶联免疫吸附试验检测幽门螺杆菌抗体蛋白IgG、并对两组胆囊黏膜标本行幽门螺杆菌免疫组织化学技术染色检测.结果:采用ELISA方法检测结石组和非结石组中H.pylori抗体蛋白,结石组中48.44%阳性,非结石组43.75%阳性,两者之间无统计学差异.采用PCR方法检测结石组和非结石组胆囊黏膜和胆汁标本中H.pylori特异性DNA片段,胆囊黏膜中结石组25例阳性(39.06%),非结石组2例阳性(12.50%),两者之间有统计学差异(P=0.04);而胆汁中结石组59.38%阳性,非结石组56.25%阳性,两者之间无统计学差异.对两组胆囊黏膜标本行免疫组织化学检测,结石组有19例阳性,在胆囊黏膜腺腔中可见棒状、弯曲杆状或球形的菌体,呈棕黄色或棕褐色.而非结石组仅有1例检出.结论:胆道中H.pylori感染在胆囊结石形成的过程中不起主要作用,而H.pylori在胆囊黏膜的定植则参与胆囊结石的形成.

AIM： To investigate the relationship between gallbladder stones and Helicobacter pylori （H. pylori） colonization of the gallbladder mucosa. METHODS： H. pylori was detected in bile and gallbladder mucosa of 64 patients with gallbladder stones （experimental group） and 16 patients without gallbladder stones （control group）. Polymerase chain reaction （PCR） was used to detect specific DNA fragments. Enzyme-linked immunoabsorbent assay （ELISA） was used to detect H. pylori IgG antibody. Immunohistochemistry was also used to detect H. pylori specific protein in gallbladder mucosa specimens. RESULTS： ELISA analysis showed that the rate of H. pylori infection did not differ significantly between the experimental group and control group （48.44% vs 43.75%, P 〈 0.05）. PCR analysis showed that the rate of H. pylori colonization of the gallbladder mucosa was significantly higher in the experimental group than in the control group （39.06% vs 12.50%, P = 0.04）, but the rate of H. pylori in bile did not significantly between the two groups （59.38% vs 56.25%, P 〈 0.05）. Immunohistochemistry analysis detected 19 positive cases in the experimental group and only 1 positive case in the control group. CONCLUSION： H. pylori infection in the biliary tract does not play a major role in the process of gallbladder stone formation, but H. pylori colonization in the gallbladder mucosa is involved in the formation of gallstones.