儿童幽门螺杆菌感染慢性胃炎与Th17细胞水平的关系

Relationship between Th17 cell number and Helicobacter pylori-infected chronic gastritis in children

目的 探讨外周血 Th17细胞水平与儿童幽门螺杆菌（Helicobacterpylori，H.pylori）感染相关慢性胃炎的关系。方法 应用胃内镜检查诊断慢性胃炎，组织病理学检查对炎性反应的程度和活动度并进行分级；13C尿素呼气试验和胃黏膜尿素酶试验均阳性则视为H.pylori感染；应用流式细胞仪检测外周血 Th17细胞占总T淋巴细胞的比值。结果 慢性胃炎伴H.pylori感染患儿（HP组，33例）、慢性胃炎非 H.pylori感染患儿（非HP组，24例）和健康儿童（健康对照组，15例）的外周血 Th17细胞数分别为（1.55 ±0.30）% 、（1.06 ±0.33）% 和（1.04±0.35）% ，HP组显著增高于非HP组和健康对照组（P均 〈0.05），非 HP组与健康对照组间差异无统计学意义（P 〉0.05）。HP组不同炎症程度患儿Th17细胞数分别为（1.64 ±0.21）%（无炎症，10例）、（1.61±0.23）%（轻度炎症，8例）、（1.25 ±0.29）%（中度炎症，9例）、（1.75 ±0.20）%（重度炎症，6例），中度炎症组Th17细胞数最低，与其他组比较差异有统计学意义（P均 〈0.05），而其余3组间比较差异无统计学意义（P 〉0.05）。HP组不同炎症活动度患者 Th17细胞数分别为（1.23 ±0.25）%（无炎症，15例）、（1.53±0.15）%（轻度炎症，6例）、（1.55±0.32）%（中度炎症，6例）、（1.71±0.35）%（重度炎症，6例），4组间比较差异无统计学意义（P 〉0.05）。结论 Th17细胞在儿童 H.pylori感染慢性胃炎的过程中可能既有抗H.pylori感染的作用，又起到对患儿胃肠道的免疫病理损害作用。这可能成为临床治疗 H.pylori感染的新靶点。

Objective To explore the relationship between peripheral Th17 cell number and chronic gastritis in Helicobacter pylori （ H. pylori） -infected children. Methods Children were diagnosed as chronic gastritis by endos- copy. The degree and activity of inflammation were graded by histopathology examinations. The patients with both 13C u- rea breath test and urease test positive were diagnosed as H. pylori infection. The peripheral Th17 cell number was measured by flow cytometry and expressed as a ratio to total T cell. Results The Th17 cell number in HP group （chro- nic gastritis with H. pylori infection, n = 33 ） , non-HP group （ chronic gastritis without H. pylori infection, n = 24 ） and normal controls （ n = 15 ） were （ 1.55 ±0.30） % , （ 1.06 ± 0.33 ） % , and （ 1.04± 0.35 ） % , respectively. HP group in- cluded a statistically higher Th17 cell number than the other groups （all P 〈 0.05 ） , while no obvious difference was found between non-HP group and controls （ P 〉 0.05 ）. According to the degree of inflammation, the chronic gastritis with H. pylori infection was categorized into non-apparent （n = 10） ,mild （n =8） ,moderate （n =9） and severe （n = 6） subgroups. The Th17 cell number in each subgroup was （ 1.64 ± 0. 21 ） % （non-apparent） , （ 1.61± 0.23） % （ mild）, （ 1.25 ± 0.29 ） % （ moderate ） and （ 1.75 ± 0.20 ） % （ severe）, respectively. The moderate group had a lowest Th17 cell number among 4 groups （ P 〈 0.05 ）. And significant differences did not exit in the other 3 groups （ P 〉 0.05 ）. The HP group patients with different inflammatory activity had a Th17 cell number of （ 1.23 ±0.25 ） % in no- napparent （n=15） ,（1.53 ±0.15）% in mild （n=6） ,（1.55 ±0.32）% in moderate （n=6） and （1.71 ±0.35）% in severe （n = 6 ） subgroup, respectively. However, there were no significant differences among 4 subgroups （P 〉 0.05 ）. Conclusions In the progress of chronic gastritis with H. pylori infection, Th17 cells may play a role as a double-edged sword by protecting and fighting against H. pylori infection and immunopathologic insults. This would provide more insights into the treatment of H. pylori infection.