儿童与成人幽门螺杆菌感染的差异

DIFFERENCE OF HELICOBACTER PYLORI INFECTION BETWEEN CHILDREN AND ADULTS

目的 :探讨幽门螺杆菌 (Helicobacter pylori,Hp)感染在儿童与成人的差异。方法 :6 0个家庭 133例伴有上消化道症状的儿童及其一级亲属接受胃镜检查 ,Hp诊断依据血清抗 Hp- Ig G抗体 ,胃组织尿素酶试验 ,组织 Warthin- Starry嗜银染色及 PCR扩增结果。采用 PCR直接扩增胃黏膜中的 Hp尿素酶 C(Ure C)基因 (82 0 bp) ,并对扩增产物分别采用限制性核酸内切酶 Hha 与 Alu 酶切消化 ,结合两种酶切类型得出 Hp的酶切类型 (PCR- RFL Pc)。结果 :儿童与亲属 Hp的检出率分别为 5 7.8%与 5 9.4 % ,两者无显著性差异 (χ2 =0 .0 0 0 1,P =0 .990 5 ) ;PCR- RFL Pc共确定 2 2个 Hp独立的酶切类型 ,儿童与其一级亲属感染相同类型 Hp的家庭共 2 6个 ,儿童与成人胃黏膜的炎症反应无显著性差异 (P >0 .0 5 ) ,但儿童胃黏膜淋巴滤泡形成率显著高于成人 (P <0 .0 5 ) ,成人 Hp感染胃黏膜肠化、萎缩及不典型增生发生率高于儿童 ,其中成人Hp感染胃黏膜萎缩发生率显著高于儿童 (P <0 .0 5 )。结论 :儿童与成人 Hp感染存在免疫反应上的差异 ,儿童时期感染 Hp。

Objective: To explore the difference of Helicobacter pylori infection between children and adults Methods: PCR-RFLP method was applied to gastric mucosa from 133 children and their first degree relatives belonging to 60 families PCR was performed on a 820 bp portion of the UreC gene of Hp, and then digested with restriction enzymes HhaⅠ and AluⅠ respectively, PCR RFLP patterns were obtained by combination of the two digestive patterns Endoscopy was carried out on all the subjects, Hp infection was determined by serum anti Hp IgG assay, Warthin Starry silver staining, urease testing and PCR Results: There was no significant difference of Hp infection rate between children and their relatives ( P>0 05) Analysis of the PCR RFLP patterns revealed 22 distinct RFLP types from 78 Hp positive family members Among 60 families, 26 shared identical genotyping Hp, the difference of severity of gastric inflammation between children and their relatives was not significant, but the incidence of lymphoid follicles in children with Hp infection was significantly higher than that in adults(P<0 05), where as the incidence of gastric atrophy was significantly higher in adults than that in children (P<0 05) Conclusions: This study demonstrated that Hp plays a crucial pathogenic role in children as well as in adults With the identical Hp infection, the incidence of lymphoid follicles in children is higher, and that of gastric atrophy is lower than that in adults, which indicates that children and adults have different immune response to Hp infection Furthermore, Hp infection at least partly contributes to the pre malignant lesion of gastric mucosa in adults