幽门螺杆菌细胞毒素相关蛋白A、热休克蛋白60和细胞空泡毒素与慢性胃炎患者胃粘膜病理变化的关系

Relationships between Helicobacter Pylori Cytotoxin Associated Protein A,Heat Shock Protein 60,Vacuolating Cytotoxin and Pathological Changes of Gastric Mucosa in Patients with Chronic Gastritis

目的分析幽门螺杆菌(Hp)细胞毒素相关蛋白A(CagA)、热休克蛋白60(HSP60)和细胞空泡毒素(VacA)与慢性胃炎患者胃粘膜病理变化的关系。方法 75例慢性胃炎患者均行胃镜检查,根据病理结果分为慢性浅表性胃炎42例(浅表组)和萎缩性胃炎33例(萎缩组)。采用14C-尿素呼气试验检测各组Hp感染情况,观察肠上皮化生情况及炎症程度,并行相关抗体检测。结果萎缩组CagA、HSP60及VacA抗体阳性率依次为69.70%、60.61%、75.76%,明显高于浅表组的42.86%、33.33%、47.62%(P<0.05)。萎缩组中,胃窦胃体均萎缩者CagA、HSP60及VacA抗体阳性率依次为90.00%、80.00%、90.00%,高于胃窦萎缩者的60.87%、52.17%、69.57%,但差异无统计学意义(P>0.05)。萎缩组肠上皮化生发生率为66.67%,显著高于浅表组的42.86%,炎症程度明显较浅表组重,差异有统计学意义(P<0.05)。本组75例患者中,有肠上皮化生的患者HSP60、VacA抗体阳性率分别为60.00%、72.50%,显著高于无肠上皮化生的患者的28.57%、45.71%(P<0.05);轻度、中度、重度炎症患者CagA抗体阳性率依次为34.62%、54.84%、83.33%,HSP60抗体阳性率依次为23.08%、54.84%、61.11%,差异有统计学意义(P<0.05)。结论 Hp致病毒素CagA、HSP60及VacA与慢性胃炎患者胃粘膜萎缩密切相关,其中CagA、Hsp60与胃粘膜炎症程度密切相关,VacA、Hsp60与胃粘膜肠化相关,均可作为慢性胃炎病情评估的重要指标。

Objective To explore the relationships between Helicobacter pylori（ Hp） cytotoxin associated protein A（CagA）,heat shock protein 60（HSP60）,vacuolating cytotoxin（VacA） and pathological changes of gastric mucosa in patients with chronic gastritis. Methods Seventy-five cases of chronic gastritis received gastroscopy and were divided into the superficial group（ chronic superficial gastritis,n = 42） and the atrophy group（ atrophic gastritis,n = 33） according to the pathological results.Hp infection was detected by14 C-urea breath test,the intestinal metaplasia and inflammation were observed,and related antibodies were detected. Results The positive rates of CagA,HSP60 and VacA antibodies were 69.70%,60.61% and 75.76% respectively in the atrophy group,which were significantly higher than those in the superficial group with 42.86%,33.33% and 47.62%（ P〉0.05）. In the atrophy group,the positive rates of CagA,HSP60 and VacA antibodies were 90.00%,80.00% and 90.00% in patients with gastric antrum and body atrophy,which were higher than 60. 87%,52. 17% and 69. 57% of patients with gastric antrum atrophy（ P〈0.05）. The incidence of intestinal metaplasia in the atrophy group was significantly higher than that in the superficial group（ 66.67% vs 42.86%）,and inflammation was significantly more serious than that in the superficial group（ P〈0.05）. Among the 75 patients,the positive rates of HSP60 and VacA in patients with intestinal metaplasia were 60. 00% and72.50% respectively,which were significantly higher than 28.57% and 45.71% in patients without intestinal metaplasia（ P〈0.05）. The positive rates of CagA antibody were 34.62%,54.84% and 83.33% respectively,and those of HSP60 antibody were 23. 08%,54. 84% and 61. 11% respectively in patients with mild,moderate and severe inflammation,and the difference was statistically significant（ P〈0.05）. Conclusion Hp viral toxin CagA,HSP60 and VacA are closely related to gastric mucosa atrophy in patients with chronic gastritis. Also,CagA and Hsp60 are closely related to the degree of gastric mucosa inflammation,and VacA and Hsp60 are related to intestinal metaplasia. All of them can be used as important indexes in the evaluation of chronic gastritis.